Rational Antibiotic Use: How Much Can Duration of Antibiotic Therapy Be Shortened?

Infectious diseases are conditions with significant consequences in terms of public health, but whose mortality, morbidity and complications can be prevented and whose disease severity and duration can be shortened by means of rational antimicrobial therapy. In planning antibiotic therapy, it is important to abide by the principles of determining the justifications for therapy, collecting and examining appropriate specimens before treatment, identifying potential micro-organism agents, understanding the pharmacological properties of the antibiotic, determining whether combined antibiotics are indicated, reviewing the host factors, determining antibiotherapy modification indications, and monitoring the response to antibiotic therapy. For rational antimicrobial therapy, once correct diagnosis has been made, the correct antibiotic must be administered via the correct route, in an effective dose, at optimum intervals, and for an appropriate length of time. However, knowledge concerning the optimal duration of the treatment initiated is limited. Patients generally receive antibiotic therapy for 10-14 days. Duration of treatment is also frequently prolonged. The length of antimicrobial therapy can be a confusing issue for clinicians due to problems of resistance and toxicity. A healthy bacterial ecosystem, a normal flora in other words, is essential in order to remain healthy. Antibiotic use can alter the normal bacterial flora in humans, and this generally leads to the emergence of antibiotic-resistant bacteria and to side-effects such as diarrhea. Infections caused by resistant bacteria result in increased disease and mortality rates and prolongation of hospital stays, as well as increased costs. Studies aimed at shortening the duration of treatment have reported that a 3-5 day treatment period in community-acquired infections and a one-week period in nosocomial infections may be sufficient. Short-term antibiotic therapy can be administered, considering patients" individual characteristics and clinical responses to treatment, in selected patient groups in both community-acquired and nosocomial infections. Rational antibiotic therapy, together with observation of response to treatment and at an optimal duration to be determined, can prevent adverse outcomes associated with long-term antibiotic use, such as antibiotic-related side-effects and development of resistance.