Shorter courses of antibiotics

Antimicrobial resistance (AMR) is a pressing public health concern, with an estimated 5,400 deaths in Canada attributed to AMR in 2018. By 2050, 40% of infections are projected to be resistant to first-line antimicrobials. To address this threat, the pan-Canadian action plan on AMR has emphasized the importance of antimicrobial stewardship. It has been commonly believed that longer courses of antibiotics are necessary to prevent AMR, but this notion is not supported by evidence. In fact, each additional day of antibiotic use is associated with an increase in AMR and a higher risk of adverse effects. Numerous randomized controlled trials have demonstrated that shorter courses of antibiotics, ranging from 5 to 7 days, are just as effective as longer courses for most acute community-acquired infections. However, there are exceptions, such as acute otitis media in children under 2 years old, where a 10-day course may be more effective. Prescribers should aim for the shortest effective duration of antibiotic therapy to promote patient adherence, slow the development of AMR, and reduce adverse effects. Choosing Wisely Canada provides evidence-based recommended durations for common respiratory infections.