Do shorter courses of antibiotics work?

Possible benefits include lower costs and increased patient compliance, but some worry that the practice may cause more adverse events and is not always appropriate.

By Victoria Stagg Elliott, AMNews staff. Jan. 21, 2002.

Infectious disease experts are increasingly debating the merits of higher doses of antibiotics over a shorter period of time.

Uncomplicated urinary tract infections could be treated in three days rather than seven. Sinusitis could be handled in seven days instead of 10. Typhoid treatment could be as short as two days, according to a paper presented by Ethan Rubinstein, MD, head of infectious diseases at the Chaim Sheba Medical Center at Tel Aviv University in Israel, during last month's Interscience Conference on Antibiotics and Chemotherapy in Chicago.

"We need to hit them early and hit them hard," said Dr. Rubinstein. "We are trying to find the minimal effective antibiotic duration that will still afford a complete cure."

Advocates say shorter courses may save money, shorten inpatient treatment and make patients more likely to take their meds. Higher doses may kill more bacteria faster and, most importantly, may be a possible solution to the emergence of resistance.

"The concept is very good. Giving a high concentration over a short course would not allow for the heavy growth of a subpopulation of resistant bacteria," said Philip Tierno, PhD, director of diagnostic microbiology and immunology at the New York University Medical Center and Mount Sinai Medical Center. "It would knock out the susceptible form, and the immune response could then eradicate those few organisms that might be resistant." [...]