Community-acquired Bacterial Respiratory Tract Infections: Consensus Recommendations

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Applied Evidence

Community-acquired Bacterial Respiratory Tract Infections: Consensus Recommendations

J Fam Pract. 2005 March;54(3):255-262

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References

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These clinical trials demonstrate that short-course therapy achieves clinical cure and/or bacteriologic eradication rates that are at least equivalent to those of standard therapy, with no significant difference in safety. Symptomatic improvement is faster and total antibiotic exposure is reduced with short-course therapy.

A significant advantage of short-course antibacterial therapy is improved patient adherence. Adherence is 10% to 20% better with 5-day courses than with 10-day courses,^47,57 and is significantly better with 1 or 2 daily doses than with 3 or more daily doses.^58-60 In fact, a recent market research study showed that patients perceive once-daily, short-course antibiotic treatment to be significantly more effective than longer courses. This may be due to faster improvement of infection-related symptoms.⁶¹ For example, Dunbar et al observed that significantly more patients treated with high-dose, short-course levofloxacin experienced subjective and objective resolution of fever by day 3 compared with those who received standard-dose, short-course levofloxacin.⁴⁸

TABLE 4

Clinical trials of high-dose, short-course antibiotic therapy

Drug regimen	N (ref)	Outcome
Amoxicillin 90 mg/kg/d x 5 d vs Amoxicillin 40 mg/kg/d x 10 d	797	Nasal carriage of penicillin nonsusceptible S pneumoniae: 24% vs 32%
	(47)
Levofloxacin 750 mg/d x 5d vs Levofloxacin 500 mg/d x 10 d	390	Clinical success: 92.4% vs 91.1% Bacteriologic eradication: 93.2% vs 92.4%
	(48)

TABLE 5 Clinical trials of standard-dose, short-course antibiotic therapy

Summary

Essential questions that need to be answered for every patient who presents with a possible CARTI include : 1) Is antibacterial therapy necessary? 2) If so, what is the best antibiotic and at what dose and for how long should it be administered? Accumulating evidence indicates that some antibiotics when given in high doses for a short duration are as effective and safe as standard therapy for CARTIs. Short-course therapy also promotes patient compliance.

Disclosures:

The authors reported the following financial relationships: Dr Brunton: consultant to Abbott, Ortho-McNeil Pharmaceutical, Inc., and SanofiAventis. Dr Carmichael: consultant to Ortho-McNeil Pharmaceutical, Inc.; on the speakers’ bureaus for Bristol-Myers Squibb Company, Merck & Co., OrthoMcNeil Pharmaceutical, Inc., and Pfizer Inc. Dr Fitzgerald: on the speakers’ bureaus for Boehringer Ingelheim, GlaxoSmithKline, Ortho-McNeil Pharmaceutical, Inc., Pfizer Inc., Sepracor Inc., and 3M. Dr Liu: on the speakers’ bureaus for Aventis Pharmaceuticals, Bayer Pharmaceuticals Corporation, Bristol-Myers Squibb Company, Cobist, GlaxoSmithKline, Merck & Co., Ortho-McNeil Pharmaceutical, Inc., Pfizer Inc., Purdue Pharma, Oscient Pharmaceuticals Corporation, and Wyeth Pharmaceuticals. Dr Varon: on the speakers’ bureau for Ortho-McNeil Pharmaceutical, Inc. Dr. Weiland: consultant to Abbott Laboratories, Ortho-McNeil Pharmaceutical, Inc., and Pfizer Inc.

This supplement to The Journal of Family Practice is supported by a grant from Ortho-McNeil Pharmaceutical, Inc. It was adapted from a consensus conference coordinated by the Primary Care Education Consortium and Texas Academy of Family Physicians and was edited and peer-reviewed by The Journal of Family Practice. © 2005 Quadrant HealthCom Inc. and Primary Care Education Consortium.