Should antibiotic courses be much shorter?
Dr Paul is to be congratulated on his article and his emphasis on
antibiotic stewardship. This must entail a substantial reduction in the
total exposure of the population to antibiotics. This might require a
radical rethink of the length of courses and dose reduction, particularly
in acute infections in the otherwise fit. On the one hand the time scale
of bacteriological propogation suggests that one dose might be sufficient
in many cases, but on the other hand, dose reduction seems inappropriate.
If subsequent doses are needed, they may well be directed at partially
resistant or relatively inaccessible organisms.
There is an urgent need to investigate very short high dose
antibiotics in the management of infections .This should not be
overshadowed by fear of increased numbers of relapses which may be a
necessary but relatively small price to pay. If relapse is entirely due to
too short a course, it will occur with sensitive organisms, so if
antibiotic is reintroduced immediately the patient should respond
satisfactorily. It is the prolonged and intermittent use of antibiotics
that leads to the development of antibiotic resistance both in organisms
responsible for the treated infection and present in the local
Competing interests: No competing interests