A review article suggests that the duration of antibiotic treatments could be reduced for most respiratory infections
• The study, led by IDIAPJGol researcher Carl Llor, shows that shortening the duration of antibiotic treatment would reduce adverse effects and minimize the risk of resistance, without affecting its effectiveness
• This conclusion needs to be confirmed in a clinical trial, which is expected to begin soon
A systematic review recently published in the journal eClinicalMedicine, part of The Lancet group, concludes that the duration of antibiotic treatments for most respiratory infections could be individualized and reduced, tailoring them to the needs of each patient. Contrary to common belief, in many cases, shortening the duration of antibiotic treatment minimizes the risk of antimicrobial resistance, while also reducing the adverse effects associated with the medication. The review, which involved Carl Llor, a researcher from the Institut d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), shows that excessively long antibiotic treatments are often prescribed in primary care consultations.
Antibiotics have been crucial in saving lives and preventing infections, but their effectiveness is at risk due to the rise of antimicrobial resistance, caused by the overuse of these medications. Approximately 80 % of antibiotics are prescribed in primary care, a significant portion of which are used to treat respiratory tract infections, which are very common. Although efforts have been made in recent years to combat the excessive use of antibiotics—such as improving patient communication, providing informational materials, utilizing rapid diagnostic tools in consultations, or applying delayed prescription strategies—only about a 4 % reduction in the average population exposure to antibiotics has been achieved.
Adjusting the treatment to the duration of symptoms
This review of published studies on the subject highlights that each person metabolizes medications differently, making the standard antibiotic treatment unsuitable for everyone. Factors such as age, comorbidities, the presence of other debilitating diseases, or the state of an individual's immune system influence the duration of treatment for each person, and in some cases, a week or even three days of treatment might be sufficient. In hospitals, biomarkers can be used to determine the optimal duration of antibiotic treatment, but these resources are often not available in primary care.
This review suggests that the duration of antibiotic treatment could be reduced when symptoms improve without losing effectiveness. However, before recommending this practice in the clinical setting, a randomized clinical trial would be necessary to compare the individualization of antibiotic treatment duration with the needs of each patient. The IDIAPJGol is expected to carry out this clinical study soon.
Carl Llor, the leader of the Primary Care Infection Research Group at IDIAPJGol and the first author of the study, emphasizes that "replacing the traditional practice of fixed-duration treatments with an individualized, patient-centered approach could improve care, reduce patients' exposure to antibiotics, decrease side effects, and help reduce antimicrobial resistance, something we will now need to validate in a clinical trial”.
Study reference
Llor C, Frimodt-Møller N, Miravitlles M, Kahlmeter G, Bjerrum L. Optimising antibiotic exposure by customising the duration of treatment for respiratory tract infections based on patient needs in primary care. EClinicalMedicine. 2024 Jul 3;74:102723. doi: 10.1016/j.eclinm.2024.102723. PMID: 39070175; PMCID: PMC11278592.
