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Knowing when to stop antibiotic therapy

Gwendolyn L Gilbert
Med J Aust 2015; 202 (3): 121-122. || doi: 10.5694/mja14.01201

Empirical antibiotic therapy that turns out to be unnecessary, on review, can (and should) be stopped immediately

After 50 years of widespread antibiotic use, we have reached the point where experts are seriously predicting “a postantibiotic era” and the World Health Organization has declared antibiotic resistance “a threat to global security”.1 No one can doubt the enormous benefits of antibiotics in curing or preventing serious sequelae of infections that were once the main causes of death and chronic illness, and enabling modern medical therapies that involve significant immune suppression.

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  • Gwendolyn L Gilbert

  • Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW.

Correspondence: lyn.gilbert@sydney.edu.au

Competing interests:

No relevant disclosures.

  • 1. World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Geneva: WHO, 2014. http://www.who.int/drugresistance/documents/surveillancereport/en (accessed Oct 2014).
  • 2. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 1997; 278: 901-904.
  • 3. Broom A, Broom J, Kirby E. Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing. Soc Sci Med 2014; 110: 81-88.
  • 4. Wutzke SE, Artist MA, Kehoe LA, et al. Evaluation of a national programme to reduce inappropriate use of antibiotics for upper respiratory tract infections: effects on consumer awareness, beliefs, attitudes and behaviour in Australia. Health Promot Int 2007; 22: 53-64.
  • 5. Goossens H, Ferech M, Vander Stichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365: 579-587.
  • 6. Filius PM, Gyssens IC, Kershof IM, et al. Colonization and resistance dynamics of gram-negative bacteria in patients during and after hospitalization. Antimicrob Agents Chemother 2005; 49: 2879-2886.
  • 7. Zarb P, Amadeo B, Muller A, et al. Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC Point Prevalence Survey 2009. J Antimicrob Chemother 2011; 66: 443-449.
  • 8. Stuart RL, Wilson J, Bellaard-Smith E, et al. Antibiotic use and misuse in residential aged care facilities. Intern Med J 2012; 42: 1145-1149.
  • 9. McGowan JE. Antimicrobial stewardship – the state of the art in 2011: focus on outcome and methods. Infect Control Hosp Epidemiol 2012; 33: 331-337.
  • 10. Davey P, Brown E, Charani E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013; (4): CD003543.
  • 11. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589-1596.
  • 12. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 14. Melbourne: Therapeutic Guidelines Limited, 2010.
  • 13. Havey TC, Fowler RA, Daneman N. Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis. Crit Care 2011; 15: R267.
  • 14. File TM Jr. Duration and cessation of antimicrobial treatment. J Hosp Med 2012; 7 Suppl 1: S22-S33.

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