Inside Health 1/8/17

Antibiotics and optimal duration of taking them

paper in BMJ

Lancet in 1999 Prof Harold Lambert
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01139-3/fulltext

2009 in Clinical Medicine – similar issues

http://www.clinmed.rcpjournal.org/content/9/6/632.1.full
do patients actually think not completing course is bad?
cite two studies
Most believed antibiotic resistance was due to excessive (median 70%, in 11 studies) or unnecessary (median 74%, in 8 studies) antibiotic use and not completing an antibiotic course (median 62%, in 8 studies)
https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkv310

These patients also had scientifically accepted explanatory models, such as resistance being due to unnecessary or to over-use of antibiotics, and not finishing a course, which might partially treat the infection allowing remaining bacteria to ‘evolve’. Others felt that being prescribed an inappropriate antibiotic could also lead to resistance:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378752/

in fact some researchers have found 5 day course for pneumonia was recommended as being good as longer courses if signs and sx developed …as far back as 1945
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2536180

uncertainty ongoing:
eg NICE

• There is a lack of evidence on the optimal duration of antibiotic treatment, but expert opinion in Guidelines on the management of cellulitis in adults [CREST, 2005] suggests that uncomplicated cases usually respond to 1–2 weeks of treatment.
• If there has been a slow response to treatment with oral antibiotics, Public Health England recommends extending the antibiotic course for a further 7 days [PHE, 2014a].

https://cks.nice.org.uk/cellulitis-acute#!scenario
numerous studies on UTI duration length ◦ If antibiotic treatment is indicated, a 3-day course of empirical treatment is recommended for most women because there is good evidence from Cochrane systematic reviews that this achieves symptomatic cure in women with uncomplicated UTI; it is more effective than single-dose treatment and as effective as 5–10-day courses [Milo et al, 2005; Lutters and Vogt-Ferrier, 2008]. This is also in line with recommendations from SIGN [SIGN, 2012], the Health Protection Agency [HPA, 2011], and an international guideline [American College of Obstetricians and Gynecologists, 2008].

◦ For women with a complicated UTI, a longer course is recommended because there is evidence from a Cochrane systematic review that a 5 to 10-day course produced a higher bacteriological cure rate (but more adverse effects) than a 3-day regimen [Milo et al, 2005]. The Cochrane systematic review concluded that a 5 to 10-day course may be considered for women in whom eradication of bacteriuria is important. CKS has extrapolated this to include women with renal impairment who may be at risk of complications from recurrent UTI, depending on clinical judgement.

• Antibiotics have little effect on the extent and duration of symptoms of sore throat in most people [NICE, 2001; Spinks et al, 2006].
• Evidence from a Cochrane review found that the absolute benefits of antibiotic treatment on the duration of symptoms were modest — a reduction of illness of about one day at around day 3 [Spinks et al, 2006].
◦ However, studies (included in the systematic review) that used three of four of the Centor criteria for bacterial infection to determine eligibility showed a little more benefit from antibiotics for both symptom resolution and prevention of complications.
ie – what is the point of prescribing them at all – telling people to stop taking them when feel better might be counter productive because it’s caused by a virus and antibiotics are not going to help and an average cough lasts 3 weeks!

 

and

screening for lung cancer

UK National Screening Committee recommendation on Lung Cancer screening in adult cigarette smokers. July 2006 https://legacyscreening.phe.org.uk/lungcancer
Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening
The National Lung Screening Trial Research Team
N Engl J Med 2011; 365:395-409August 4, 2011DOI: 10.1056/NEJMoa1102873
Yousaf-Khan U, van der Aalst C, de Jong PA, et al Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval Thorax 2017;72:48-56.
Lung Cancer Early Diagnosis Rates Soar During UK-first CT Community Scanner Pilot in Manchester by UHSM

Lung Cancer Early Diagnosis Rates Soar During UK-first CT Community Scanner Pilot In Manchester by UHSM


Khomami N. The Guardian, 13/1/16
https://www.theguardian.com/society/2016/jan/13/local-authorities-budgets-stop-smoking-services

Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers
Horeweg, Nanda et al.
The Lancet Oncology , Volume 15 , Issue 12 , 1342 – 1350http://thorax.bmj.com/content/early/2016/06/30/thoraxjnl-2016-208655

Macmillan report 

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