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Posted on 06/10/2006 1:54:05 AM PDT by neverdem
Cutting the length of time that patients take certain antibiotics could help to tackle the rise in drug resistance. So say the authors of a study showing that just three days' worth of drugs can fight pneumonia just as well as a longer treatment.
Many antibiotics are prescribed for a week, ten days, or more, and patients are usually told to finish the course of pills to ensure that all the infection-causing bugs are eradicated. It is widely thought that not finishing the full course of drugs may allow a few of the hardiest bugs to linger, raising the risk that an antibiotic-resistant population of bacteria can then develop.
But there is no particular reason for the length of some antibiotic treatments, says infectious-disease expert Jan Prins of the Academic Medical Center in Amsterdam, the Netherlands. In general, the drugs are given for five, seven or ten days simply because that's what worked in the initial trials.
Three-day cure
Prins and his colleagues decided to test the conventional wisdom. They studied people admitted to Netherlands hospitals with pneumonia, because respiratory tract infections of this type are one of the most common reasons that antibiotics are prescribed. The standard length of antibiotic treatment for pneumonia is 7-10 days.
The researchers treated each patient with a three-day intravenous course of the antibiotic amoxicillin. Of the 119 who improved, half continued to receive antibiotic pills for another five days, and another half were given a placebo pill.
Four weeks after the start of treatment, nearly 90% of patients in both groups were considered cured of the infection. Three days' worth of drugs was enough to kill most of the bacteria; the other five seemed to be superfluous.
At least for pneumonia, the finding counters the idea that a fleeting dose of antibiotics might allow some resilient bugs to survive and develop antibiotic resistance. "There's no reason to assume you leave semi-resistant bacteria behind," Prins says. Their results are published in the British Medical Journal1.
Testing time
In fact, the reverse could be true: unnecessarily long drug courses could fuel overuse of antibiotics and actually encourage bacteria in our guts to acquire and spread resistance. The recommended time course for some other antibiotics for ear and urinary tract infections has already been shortened because of similar studies; for some types of throat infection, the use of antibiotics is discouraged altogether because most patients get better on their own.
"There is always the possibility that a lower dose or shorter duration might be equally efficacious," says infectious disease specialist Jim Wilde at the Medical College of Georgia, Augusta.
Medical researchers now have to prove that other antibiotic courses can be shortened, by testing each infection and each antibiotic treatment in similar studies. "You have to find out for each infection which is the best course," Prins says.
Until those results are in, the researchers are keen to emphasize that patients should not stop taking their prescribed antibiotics prematurely. For many infections there is strong evidence that the drugs should be taken for a week or longer.
"You want to treat not too little and not too long," says Wilde. "But in many cases you don't have the exact number."
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 Story from news@nature.com: http://news.nature.com//news/2006/060605/060605-14.html |
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doi:10.1038/news060605-14
This is bold research, IMHO. The link is to the complete article. I only read the abstract and introduction. I hope it can be replicated for community acquired pneumonia. I would not extrapolate the results to other diagnoses.
Interesting stuff. Thanks for posting!
Yeah, what worked in the trials was that no one got diarrhea during that time. So, the "most effective" dose becomes the one that requires taking the most number of pills before causing such an unpleasant side effect.
This is very interesting research, thanks very much for posting.
But penicillin (amoxicillin) is a unique situation. There is nothing new here. Few doctors prescribe amoxicillin for 10 days.
Treatment for strep with penicillin, for instance, is often a single shot to the buttocks.
You may be onto something here...
You may be onto something here...
Yes, I think I am.
That is why I'm surprised to see research that would even suggest that fewer doses could be effective. As you mentioned, a one time, big dose of penicillin is often standard treatment.
Smells like bullshit to me. I fail to see how a "too long" treatment can breed resistant bacteria, but a "too short" treatment period, with recurrence and retreatment certainly CAN cause such.
There is no reason for that "unpleasant side effect" to EVER happen. The reason antibiotics cause diarrhea is that they kill off the beneficial gastrointestinal tract flora as well as the bothersome bacteria. Which means your GI tract simply doesn't work (or as well). EVERY doctor who prescribes antibiotics should recommend that their patients either eat "active culture yogurt", or go down to the local health food store and buy a bottle of acidophius capsules.
If you take antibiotics long enough WITHOUT the acidophilus, you risk an explosive growth of candida-type fungi, which can REALLY do "bad things" to your body. It happened to me, and it literally took YEARS to fully recover.
Who provides your medical malpractice coverage?
Where are your references for treating community acquired pneumonia besides the British Medical Journal article and the references it provides?
And your point is??? Just because there is ONE article in the "British Medical Journal", I'm supposed to buy what it says automatically?? Especially when it goes counter to the commonly accepted medical understanding on the acquisition by bacteria of antibiotic resistance??
BTW--the most widely regarded medical Journal in Britain is the "Lancet".
I agree: 3 days of amoxicillin for pneumonia is just as good as 8 days, if the patients have already gotten better by 3 days.
Seriously -
"Our results apply only to patients with mild to moderate-severe community acquired pneumonia who substantially improved after three days' amoxicillin treatment. The conclusions do not apply to the population with severe community acquired pneumonia—that is, those with a pneumonia severity index score of more than 110 or serious respiratory insufficiency. We also excluded patients with a severe immunodeficiency syndrome or a significant amount of pleural fluid. "
I would imagine that we should continue to treat sepsis, abcesses, and mixed infections in those who are immunocompromised (diabetes, COPD, etc.) with wide spectrum, long course meds.
Viral or bacterial?
That is a common reason but not the only reason. Sometimes oral antibiotics can cause diarrhea in fewer than 24 hours and that has nothing to do with killing the beneficial bacteria. Of course, your suggestion to take a supplement is a good one.
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On the duration of the antibiotic course, I know that my wife's stubborn sinus infections aren't knocked out by fewer than 15-20 days of treatment. A shorter course such as ten days will cause an improvement, but the infection bounces right back.
Indeed;
For Instance:
Pakistan Multicentre Amoxicillin Short Course Therapy (MASCOT) pneumonia study group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial.Lancet 2002; 360: 835-41. Current WHO guidelines:
A simplified and efficient drug regimen is especially important in complex emergencies. Effective, shortcourse antibiotics need to be identified for pneumonia, shigella dysentery, and sexually transmitted infections, with appropriate education about compliance and treatment. A 3-day regimen of amoxicillin in treating childhood pneumonia is as effective as a 5-day course, which is commonly used in developing countries.Lancet 2004; 364(9449): 1974-1983.
I forgot to mention that my dad had an episode similar to yours and never did fully get over it (for decades). It wasn't possible to go to the drugstore then and purchase acidophilus and I'm not sure if varieties of yogurt were common. There was buttermilk. Not known if Candida/yeast was involved.
After the article's recommendation of the three day course of amoxicillin for community acquired pneumonia, I was responding to:
Smells like bullshit to me. I fail to see how a "too long'" treatment can breed resistant bacteria, but a "too short" treatment period, with recurrence and retreatment certainly CAN cause such.
With the exception of azithromycin, I can't find an antibiotic with a course of treatment for community acquired pneumonia that is less than 7 days.
The presumptive diagnosis in the article is bacterial. Thank you for the previous citations, but I was thinking of the USA where there is a lot of resistance to beta lactam antibiotics. Replicating their results in this country with amoxicillin only, i.e. not as Augmentin which is amoxicillin plus clavulanate, would be surprising to more than just me, IMHO.
Above from your link: "Excessive use" is NOT the same as a single long course of treatment.
As I said, I don't see how a continuous LONGER single use term of antibiotics can possibly cause antibiotic resistance compared to a SHORT single use term. I can easily understand how the reverse is possible, though.
And with Azithromycin, don't let the doctor stick you with the "three-day" course. It is NOT as effective as the "five-day" course.
It took me ten years to FULLY recover, though once I started treatment for Candida, the recurring bouts of diarrhea were cured in a few months. But the affects on immune system and other organs took a LONG time to fully heal.
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