Short-Course Antibiotic Prescribing Clinical Practice Guidelines (ACP, 2021)

American College of Physicians

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 29, 2021

Guidelines on appropriate short-course antibiotics in common infections were published in April 2021 by the American College of Physicians in the Annals of Internal Medicine.[1,2]

Chronic Obstructive Pulmonary Disease and Uncomplicated Bronchitis

If patients with chronic obstructive pulmonary disease and acute uncomplicated bronchitis show signs of bacterial infection, such as increased purulence of sputum, along with increased dyspnea and/or volume of sputum, antibiotic treatment should be limited to 5 days' duration.

Antibiotic choice is based on the most common bacterial etiologies, which include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.

Recommended therapeutic agents include aminopenicillin with clavulanic acid, macrolides, and tetracyclines.

Community-Acquired Pneumonia

The minimum duration of antibiotic therapy for community-acquired pneumonia is 5 days. Any extension of antibiotic therapy beyond 5 days should be based on validated measures of clinical stability; these measures include (1) resolution of vital sign abnormalities, (2) ability to eat, and (3) normal mentation.

Antibiotic choice is based on the most common bacterial etiologies, which include S pneumoniae, H influenzae, Mycoplasma pneumoniae, and Staphylococcus aureus, along with atypical pathogens (eg, Legionella species).

Recommended therapeutic agents include amoxicillin, doxycycline, or a macrolide in healthy adults or, in patients with comorbidities, a beta-lactam with a macrolide or a respiratory fluoroquinolone.

Urinary Tract Infections

In men or women who have uncomplicated pyelonephritis, the recommendation is for a short course of antibiotic therapy with either fluoroquinolones (5-7 days) or trimethoprim-sulfamethoxazole (14 days), based on antibiotic susceptibility.

In women with uncomplicated bacterial cystitis, the recommendation is for a short course of antibiotics with nitrofurantoin (5 days), trimethoprim-sulfamethoxazole (3 days), or fosfomycin (single dose).

Cellulitis

For nonpurulent cellulitis, a 5- to 6-day course of antibiotic therapy active against streptococcal species is recommended (eg, cephalosporin, penicillin, clindamycin); this is particularly appropriate for patients who are able to self-monitor and for those who have close follow-up primary care.

These recommendations do not apply to patients with purulent cellulitis (eg, abscesses, furuncles, carbuncles) or suspected infection with methicillin-resistant S aureus (MRSA).

For more information, please go to Chronic Obstructive Pulmonary Disease (COPD), Bronchitis, Community-Acquired Pneumonia (CAP), Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Urinary Tract Infection (UTI) in Males, and Cellulitis.

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