Antibiotic treatment durations for common infectious diseases in Switzerland: comparison between real-life and local and international guideline recommendations

Objectives: Shortening the duration of antibiotic therapy (DAT) for common infectious diseases may be an effective strategy to tackle antimicrobial resistance. Shorter DAT has been proven safe and effective for community-acquired pneumonia (CAP), cellulitis, and cholangitis.Methods: In a retrospective multicentre quality-control study, medical records of 770 patients hospital-ized with CAP, cellulitis, and cholangitis at three tertiary care hospitals in Switzerland during 2017-2018 were randomly selected. Appropriateness of antibiotic treatment duration was assessed according to in-ternational and local guidelines.Results: Records of 271, 260, and 239 patients with CAP, cellulitis, and cholangitis were included, respec-tively. Median DAT was seven days (interquartile range [IQR] 6-9), ten days (IQR 8-13), and nine days (IQR 6-13) in CAP, cellulitis, and cholangitis, respectively. DAT longer than recommended by local and international guidelines was observed in 32% and 37% of CAP patients, 23% and 70% of cellulitis patients, and 33% and 37% of cholangitis patients, respectively. Positive blood cultures (odds ratio [OR] = 2.42 (95% confidence interval [CI] 1.33-4.34]), infectious diseases consultation (OR = 1.79 [95% CI 1.05-2.78]), impaired renal function (OR = 0.99 [95% CI 0.98-1.0 0] per 1 ml/min / 1.73 m 2 increase in estimated glomerular filtration rate) and a higher degree of inflammation on admission (OR = 1.0 [95% CI 1.001- 1.005] per 10 mg/L increase in C-reactive protein) were independently associated with a DAT longer than recommended in international guidelines.Conclusions: DAT exceeded recommendations in a significant proportion of patients with mostly community-acquired infections.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Automated summary

Shortening the duration of antibiotic therapy for common infectious diseases, such as community-acquired pneumonia, cellulitis, and cholangitis, has been proven safe and effective in tackling antimicrobial resistance.