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Background: Antibiotic treatment duration may be longer than sometimes needed. Stopping antibiotics early, rather than completing pre-set antibiotic courses, may help reduce unnecessary exposure to antibiotics and antimicrobial resistance (AMR). Aim: To identify clinicians' and patients' views on stopping antibiotics when better (SAWB) for urinary tract infections (UTIs), and to explore comparisons with other acute infections. Design & setting: An exploratory qualitative study with general practice clinicians and patients in England. Method: Primary care clinicians and patients who had recent UTI experience were recruited in England. Remote one-to-one interviews with clinicians and patients, and one focus group with patients, were conducted. Data were audiorecorded, transcribed, and analysed thematically. Results: Eleven clinicians (seven GPs) and 19 patients (14 with experience of recurrent and/or chronic UTIs) were included. All participants considered SAWB unfamiliar and contradictory to well-known advice to complete antibiotic courses, but were interested in the evidence for risks and benefits of SAWB. Clinicians were amenable if evidence and guidelines supported it, whereas patients were more averse because of concerns about the risk of UTI recurrence and/or complications and AMR. Participants viewed SAWB as potentially more appropriate for longer antibiotic courses and other infections (with longer courses and lower risk of recurrence and/or complications). Participants stressed the need for unambiguous advice and SAWB as part of shared decision making and personalised advice. Conclusion: Patients were less accepting of SAWB, whereas clinicians were more amenable to it. Patients and clinicians require good evidence that this novel approach to self-determining antibiotic duration is safe and beneficial. If evidence based, SAWB should be offered with an explanation of why the advice differs from the ‘complete the course’ instruction, and a clear indication of when exactly to stop antibiotics should be given.

Background: Prolonged antibiotics are associated with toxicity, selection for resistant organisms, and secondary infections such as Clostridioides difficile colitis. Emerging clinical data suggest that short courses of antibiotics can be used for common bacterial infections among immune competent patients, but for many randomized controlled trials (RCTs), immunocompromised patients, including solid organ transplant recipients (SOTRs), have been excluded. Methods: Peer‐reviewed publications were identified through PubMed and Embase searches. Results: We review data examining shorter antibiotic courses among immunocompetent and immunocompromised patients and the rationale for use of short antibiotic courses in SOTRs. Conclusion: There are known harms associated with antibiotics and, when studied, existing data do not demonstrate harm associated with shorter courses of antibiotics among SOTRs. Furthermore, several RCTs did include some immune compromised patients and found shorter therapy to result in similar clinical efficacy with diminished adverse effects. Shorter antibiotic durations should be considered in SOTRs, and questions of antibiotic duration among SOTRs should be prioritized for study in clinical trials. [ABSTRACT FROM AUTHOR]

The article provides information on the influence of medical education and the need for clinician educators to stay updated on evidence-based practices. It discusses a study that examines the optimal duration of antibiotic treatment for complicated urinary tract infections with concomitant bacteremia, emphasizing the inclusion of immunocompromised and critically ill patients.

This study was undertaken to investigate the relationship between cerebrospinal fluid abnormalities and prognosis in pediatric refractory purulent meningitis. Ninety cases of pediatric refractory purulent meningitis were stratified into “good” (n = 33) or “poor” (n = 57) prognosis groups according to the Glasgow clinical outcome scores. The symptoms, laboratory results, and prognosis were compared by using univariate and multivariate logistic regression analyses. Univariate analysis showed that poor prognosis was associated with: unequal pupil size in both eyes; positive Babinski sign; CSF-WBC >500 × 10 6 /L, CSF protein concentration >1.0 g/L, CSF glucose content <1.5 mmol/L; initial procalcitonin result >0.1 ng/dL on admission; hemoglobin <90 g/L during hospitalization; abnormal head imaging, and abnormal electroencephalogram. On multivariate analysis only unequal pupil size in both eyes and CSF glucose content <1.5 mmol/L remained significant. The CSF protein concentration was significantly different between groups at discharge. The cutoff value was 0.68 g/L. We recommend that discharged patients meet the following criteria: full antibiotic course and over 1 week of defervesce, disappearance of acute phase symptoms, CSF-WBC ≤28 × 10 6 /L, CSF glucose >1.75 mmol/L, and protein <0.68 g/L. The patient may be discharged for follow-up if no relapse occurs during 3–5 days of observation after drug withdrawal. [ABSTRACT FROM AUTHOR]

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations. [ABSTRACT FROM AUTHOR]