Doctors’ Group Says Antibiotics Can Be Taken for Shorter Periods

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Millions of Americans have at some point in their lives gotten a long course of antibiotics to treat a bacterial infection. But according to new recommendations from a major U.S. doctors’ group, some of the most common bacterial infections can now be treated with shorter courses of the drugs.

The advice, from the American College of Physicians (ACP), says that for several types of infections, shorter courses of antibiotics do the job — and even do it more safely.

The conditions include straightforward cases of pneumonia, skin infection and urinary tract infection (UTI), meaning they are not complicated by other medical conditions.

In general, the ACP says, they can be managed with five to seven days of antibiotics, or even three days in certain cases, instead of the traditional 10 days or more.

Many patients are accustomed to long courses, but their use was largely based on “conventional wisdom,” said ACP president Dr. Jacqueline Fincher.

In recent years, she said, clinical trials have shown that shorter courses are just as effective at “eradicating” many infections.

It’s a safer approach, too, Fincher explained: Shorter courses lessen the chance of side effects like nausea and diarrhea. They may also help battle the widespread problem of antibiotic resistance — where bacteria that are exposed to an antibiotic mutate in an attempt to thwart the drug.

Antibiotics, especially long courses, can also kill “good” bacteria that normally dwell in the body and help keep its various systems running smoothly, Fincher said.

Yeast infections, she noted, are one example of how that balance can be upset: When women take an antibiotic for a UTI, that can diminish the good bacteria that normally keep yeast growth in check.

One particular concern, Fincher said, are potentially fatal gut infections caused by antibiotic-resistant C. difficile bacteria. Those infections often arise after a person has had antibiotic treatment that destroyed many of the good bacteria in the gut.

The new ACP recommendations advise shorter antibiotic courses for four groups of infection:

  • Acute bronchitis in people with chronic obstructive pulmonary disease. COPD is an umbrella term for two serious lung conditions: emphysema and chronic bronchitis. When COPD patients develop worsening symptoms (acute bronchitis) and the cause is likely a bacterial infection, the ACP advises antibiotic treatment for a maximum of five days. (In previous advice, the ACP has said that people without COPD do not need antibiotics for acute bronchitis — unless they may have pneumonia.)
  • Pneumonia. When people develop uncomplicated pneumonia, antibiotics should be given for a minimum of five days, and possibly longer depending on symptoms.
  • UTIs. Treatment can often be five to seven days, or even shorter. Women may be able to take the antibiotic combination trimethoprim-sulfamethoxazole for three days, or a newer antibiotic called fosfomycin as a single dose.
  • Cellulitis. This is a common skin infection that often affects the limbs. As long as the infection does not involve pus (such as an abscess), it can be treated with antibiotics for five to six days.

Fincher said the advice focused on those four groups, in part, because they are so common. But shorter courses could also be appropriate for other less serious infections, she added.

Some conditions will still need longer courses, Fincher said — including “deep” infections like osteomyelitis, where there is inflammation of the bone. Longer treatment may also be better for certain patients, like those with diabetes or compromised immune systems, she noted.

“Antibiotics can be lifesaving, but like any medication, they have side effects,” said Dr. Helen Boucher, a member of the Infectious Diseases Society of America’s Board of Directors.

First, it’s important for patients to be sure they really need an antibiotic, said Boucher, who also heads the infectious diseases division at Tufts Medical Center in Boston.

An estimated 30% of antibiotic prescriptions in the United States are unnecessary, she noted.

“Ask your doctor, ‘Do I really need this?'” Boucher advised. The next question, she said, can be about duration: If the prescription is for 10 days — the “default” for many doctors, the ACP says — patients can again ask why.

Why are shorter courses being advocated now? It was only in recent years that clinical trials began testing shorter versus longer antibiotic treatment, Boucher explained. (Drug companies do not have much incentive to study less treatment, she noted.)

It was the problem of antibiotic resistance, Boucher said, that spurred researchers to see whether shorter courses could be just as effective.

The recommendations were published in the ACP journal Annals of Internal Medicine.

Source: HealthDay

Be Antibiotics Aware: Smart Use, Best Care

Antibiotic resistance is one of the most urgent threats to the public’s health. Antibiotic resistance happens when germs, like bacteria and fungi, develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. More than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result.

Antibiotics can save lives, but any time antibiotics are used, they can cause side effects and contribute to the development of antibiotic resistance. Each year, approximately 28% of antibiotics are prescribed unnecessarily in doctors’ offices and emergency rooms (ERs), which makes improving antibiotic prescribing and use a national priority.

Helping healthcare professionals improve the way they prescribe antibiotics, and improving the way we take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that these life-saving drugs will be available for future generations.

When Antibiotics Are Needed

Antibiotics are only needed for treating certain infections caused by bacteria. We rely on antibiotics to treat serious, life-threatening conditions such as pneumonia and sepsis, the body’s extreme response to an infection. Effective antibiotics are also needed for people who are at high risk for developing infections. Some of those at high risk for infections include patients undergoing surgery, patients with end-stage kidney disease, or patients receiving cancer therapy (chemotherapy).

When Antibiotics Aren’t Needed

Antibiotics do not work on viruses, such as those that cause colds, flu, bronchitis, or runny noses, even if the mucus is thick, yellow, or green.

Antibiotics are only needed for treating certain infections caused by bacteria, but even some bacterial infections get better without antibiotics. Antibiotics aren’t needed for many sinus infections and some ear infections. Antibiotics can save lives, and when a patient needs antibiotics, the benefits usually outweigh the risks of side effects and antibiotic resistance. When antibiotics aren’t needed, they won’t help you, and the side effects could still cause harm. Common side effects of antibiotics can include:

  • rash
  • dizziness
  • nausea
  • diarrhea
  • yeast infections

More serious side effects include Clostridioides difficile infection (also called C. difficile or C. diff), which causes severe diarrhea that can lead to severe colon damage and death. People can also have severe and life-threatening allergic reactions, such as wheezing, hives, shortness of breath, and anaphylaxis (which also includes feeling like your throat is closing or choking, or your voice is changing).

What You Can Do To Feel Better

  • Talk with your healthcare professional about the best treatment for you or your loved one’s illness.
  • If you need antibiotics, take them exactly as prescribed. Talk with your healthcare professional if you have any questions about your antibiotics.
  • Talk with your healthcare professional if you develop any side effects, especially severe diarrhea, since that could be a C. diff. infection, which needs to be treated immediately. Respiratory viruses usually go away in a week or two without treatment. Ask your healthcare professional about the best way to feel better while your body fights off the virus.

To stay healthy and keep others healthy:

  • Clean hands by washing with soap and water for at least 20 seconds or use a hand sanitizer that contains at least 60% alcohol.
  • Cover your mouth and nose with a tissue when you cough or sneeze.
  • Stay home when sick.
  • Get recommended vaccines, such as the flu.

Source: CDC

Are Antivitamins the New Antibiotics?

Antibiotics are among the most important discoveries of modern medicine and have saved millions of lives since the discovery of penicillin almost 100 years ago. Many diseases caused by bacterial infections – such as pneumonia, meningitis or septicaemia – are successfully treated with antibiotics. However, bacteria can develop resistance to antibiotics which then leaves doctors struggling to find effective treatments. Particularly problematic are pathogens which develop multi-drug resistance and are unaffected by most antibiotics. This leads to severe disease progression in affected patients, often with a fatal outcome. Scientists all over the world are therefore engaged in the search for new antibiotics. Researchers at the University of Göttingen and the Max Planck Institute for Biophysical Chemistry Göttingen have now described a promising new approach involving “antivitamins” to develop new classes of antibiotics. The results were published in the journal Nature Chemical Biology.

Antivitamins are substances that inhibit the biological function of a genuine vitamin. Some antivitamins have a similar chemical structure to those of the actual vitamin whose action they block or restrict. For this study, Professor Kai Tittmann’s team from the Göttingen Center for Molecular Biosciences at the University of Göttingen worked together with Professor Bert de Groot’s group from the Max Planck Institute for Biophysical Chemistry Göttingen and Professor Tadgh Begley from Texas A&M University (USA). Together they investigated the mechanism of action at the atomic level of a naturally occurring antivitamin of vitamin B1. Some bacteria are able to produce a toxic form of this vital vitamin B1 to kill competing bacteria. This particular antivitamin has only a single atom in addition to the natural vitamin in a seemingly unimportant place and the exciting research question was why the action of the vitamin was still prevented or “poisoned”.

Tittmann’s team used high-resolution protein crystallography to investigate how the antivitamin inhibits an important protein from the central metabolism of bacteria. The researchers found that the “dance of the protons”, which can normally be observed in functioning proteins, almost completely ceases to function and the protein no longer works. “Just one extra atom in the antivitamin acts like a grain of sand in a complex gear system by blocking its finely tuned mechanics,” explains Tittmann. It is interesting to note that human proteins are able to cope relatively well with the antivitamin and continue working. The chemist de Groot and his team used computer simulations to find out why this is so. “The human proteins either do not bind to the antivitamin at all or in such a way that they are not ‘poisoned’,” says the Max Planck researcher. The difference between the effects of the antivitamin on bacteria and on human proteins opens up the possibility of using it as an antibiotic in the future and thus creating new therapeutic alternatives.

Source: University of Göttingen

Study: ‘No Clear Rationale’ for 45% of Antibiotic Prescriptions

Nearly half of antibiotic prescriptions for Medicaid patients appear to be inappropriate, new research suggests.

That kind of overprescribing raises risks for everyone, experts say, as bacteria gain more chances to mutate around the life-saving drugs.

For the study, researchers analyzed 298 million antibiotic prescriptions filled by 53 million Medicaid patients between 2004 and 2013. They found that 45% were ordered without any clear rationale.

Specifically, 17% were prescribed at an office visit in which the patient wasn’t diagnosed with a bacterial infection, and 28% were prescribed without an office visit.

“Indiscriminate use of antibiotics is increasing the prevalence of antibiotic-resistant bacteria and rendering them ineffective,” said senior author Dr. Jeffrey Linder, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine, in Chicago.

“It’s concerning that nearly half of antibiotics are prescribed without a visit or without a clear rationale,” he added in a university news release. “We are not keeping track of and do not have a system to ensure high-quality antibiotic prescribing in the U.S.”

The study was published in the February issue of the journal Health Affairs.

The study’s lead author, Dr. Michael Fischer, is an associate professor at Harvard Medical School. He said, “If we’re thinking about how to improve antibiotic use, we need to understand the context in which antibiotics are being prescribed. If prescribing is taking place outside of an office visit, most of the approaches we’re taking to combat antibiotic overuse will miss those completely.”

A key question remains unanswered: Under what circumstances were antibiotics prescribed without a visit to the health care provider?

The study was based on insurance claims and not on medical records, Fischer said, so researchers don’t know what interactions took place between patients and prescribing doctors.

“We assume that most of these prescriptions were associated with a telephone interaction, although some communication may have occurred over email, via web portals or in informal, uncaptured visits,” he said. “Most of these encounters would be blind spots for the interventions designed to improve antibiotic use.”

Source: HealthDay

New Guideline: Antibiotics Not Recommended for Most Toothaches

Antibiotics aren’t necessary for most toothaches, a new American Dental Association (ADA) guideline says.

It’s common for doctors and dentists to prescribe antibiotics to ease toothache symptoms and prevent a more serious condition.

But a review that led to the new guideline concluded that antibiotics are not the best option for adults with a toothache. Instead, they should get dental treatment and, if needed, use over-the-counter pain relievers such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil), according to the ADA.

“Antibiotics are, of course, tremendously important medications,” said Dr. Peter Lockhart, chairman of the expert panel that developed the new guideline. “However, it’s vital that we use them wisely so that they continue to be effective when absolutely needed.”

Lockhart is chairman of the department of oral medicine at Carolinas Medical Center–Atrium Health in the Charlotte metro area.

Antibiotics are designed to combat bacterial infections, but they don’t necessarily help with a toothache. They can cause serious side effects, and overuse has resulted in bacteria that are resistant to antibiotics.

The guideline does provide examples when antibiotics may be prescribed for a toothache.

“When dental treatment is not immediately available and the patient has signs and symptoms such as fever, swollen lymph nodes, or extreme tiredness, antibiotics may need to be prescribed,” Lockhart said in an ADA news release. “But in most cases when adults have a toothache and access to dental treatment, antibiotics may actually do more harm than good.”

The new guideline appears in the November issue of the Journal of the American Dental Association.

Source: HealthDay