Short course antibiotic therapy for respiratory infections: a review of the evidence.

BACKGROUND: The judicious use of antibiotics entails achieving the appropriate balance between prescribing them with sufficient frequency and duration to effect a clinical cure for bacterial infections and overprescribing them, a practice that increases prescription drug costs as well as the risks of bacterial resistance, noncompliance with therapy and side effects. The recognition that the traditional 10-day or greater duration of therapy for acute otitis media, tonsillopharyngitis and sinusitis does not derive from a strong scientific or medical rationale (with the exception of penicillin therapy for tonsillopharyngitis) and the increasing awareness of the adverse sequelae of long-duration antibiotic therapy have led some clinicians to call for shortening the duration of antibiotic therapy in these infections. The soundness of this recommendation hinges on the demonstration that shortened courses of antibiotic therapy are at least as effective as traditional courses of therapy. SYNOPSIS: Data relevant to determining the optimum duration of therapy in acute otitis media, tonsillopharyngitis and sinusitis are reviewed in this article. The review demonstrates particularly strong justification for shortening the duration of therapy from the standard 10 days to 5 days in acute otitis media, in which numerous open label and controlled studies have shown equivalent efficacy of the two durations of regimen. A growing body of evidence indicates that tonsillopharyngitis, too, can be effectively treated with non-penicillin antibiotics given for fewer than 10 days. Although sinusitis data are less plentiful than those for acute otitis media and tonsillopharyngitis, the results available to date are encouraging in suggesting that shortened courses of therapy may also be appropriate for acute maxillary sinusitis.