Study: Antibiotic Prescription Durations for Common Infections Often Exceed Guidelines

October 5, 2020

Over half of antibiotic courses in a new study exceeded guideline-recommended minimum effective durations, translating to >54 million potentially excessive days.

The median duration of antibiotic courses for most common conditions, except acute cystitis, was 10 days, exceeding guideline-recommended durations in many cases, according to a recent study published in the September issue of Clinical Infectious Diseases.

Researchers from the US Centers for Disease Control and Prevention and the Division of Pediatric Infectious Diseases at the University of Utah, “found that clinicians frequently defaulted to 10-day durations even when guidelines recommend shorter durations, potentially exposing patients to unnecessarily long antibiotic therapy durations for many common conditions.”

Although unnecessary outpatient antibiotic prescribing is quite common, researchers wanted to examine the durations of antibiotic prescriptions for common bacterial infections leading to outpatient prescriptions.

Researchers identified >28 million antibiotic prescriptions associated with streptococcal pharyngitis, sinusitis, acute otitis media, community-acquired pneumonia (CAP), skin and soft tissues infection, and acute cystitis using the 2017 dataset from the National Disease and Therapeutic Index (NDTI).

The NDTI is a 2-stage stratified cluster sample of US private-practice and office-based physicians. It should be noted that prescriptions for azithromycin were excluded because of its substantially different duration recommendations vs other antibiotics.

The researchers found that the median antibiotic duration for each condition was 10 days, except for acute cystitis, which was 7 days (interquartile range [IQR], 5-7 days). Overall, 55% (95% confidence interval [CI], 53%-58%) of antibiotic courses exceeded guideline-recommended minimum effective durations, translating to up to 54 496 316 potentially excessive days of therapy.

Among adults (aged ≥18 years), 74% (95% CI, 71%-77%) of antibiotic courses exceeded minimum guideline-recommended durations vs 36% (95% CI, 33%-39%) in children (aged <18 years).

“Compliance with recommended duration of antibiotic therapy could be improved for sinusitis and CAP in adults, cellulitis in all ages, and acute cystitis in women 12-64 years,” concluded authors. “Increased focus on appropriate duration of antibiotic therapy for these common conditions could reduce unnecessary outpatient antibiotic use.”