Borek A J, Ledda A, Pouwels K B, Butler C C, Hayward G, Walker A S, Robotham J V, Tonkin-Crine S
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK.
JAC Antimicrob Resist. 2024 Sep 9;6(5):dlae147. doi: 10.1093/jacamr/dlae147. eCollection 2024 Oct.
Shortening standard antibiotic courses and stopping antibiotics when patients feel better are two ways to reduce exposure to antibiotics in the community, and decrease the risks of antimicrobial resistance and antibiotic side effects. While evidence shows that shorter antibiotic treatments are non-inferior to longer ones for infections that benefit from antibiotics, shorter courses still represent average treatment durations that might be suboptimal for some. In contrast, stopping antibiotics based on improvement or resolution of symptoms might help personalize antibiotic treatment to individual patients and help reduce unnecessary exposure. Yet, many challenges need addressing before we can consider this approach evidence-based and implement it in practice. In this viewpoint article, we set out the main evidence gaps and avenues for future research.
缩短标准抗生素疗程以及在患者感觉好转时停用抗生素是减少社区抗生素暴露、降低抗菌药物耐药性风险和抗生素副作用的两种方法。虽然有证据表明,对于受益于抗生素治疗的感染,较短疗程的抗生素治疗并不逊色于较长疗程,但较短疗程仍代表着平均治疗时长,对某些患者而言可能并非最佳。相比之下,根据症状改善或缓解情况停用抗生素可能有助于针对个体患者进行个性化抗生素治疗,并有助于减少不必要的暴露。然而,在我们能够认为这种方法基于证据并在实践中实施之前,还有许多挑战需要解决。在这篇观点文章中,我们阐述了主要的证据空白以及未来研究的方向。