Author: Guay D.R.P.

Source: Drugs, Volume 63, Number 20, 2003 , pp. 2169-2184(16)

Publisher: Adis International

Abstract:

Accumulating evidence suggests that short-course (5 days, 3 days for azithromycin) antimicrobial therapy may be at least as effective as and, in some cases, may be more effective than traditional longer (10- to 14-day) therapies.

In group A -haemolytic streptococcal tonsillopharyngitis, short-course therapy with 6 days of amoxicillin, 4–5 days of a variety of cephalosporins and 5 days of clarithromycin modified-release and telithromycin are all reasonable alternatives to traditional 10-day penicillin therapy. Short-course (i.e. 3-day) azithromycin therapy is not recommended because of suboptimal clinical and bacteriological results compared with penicillin therapy, unless the dosage is doubled from 10 to 20 mg/kg/day for all 3 days.

In uncomplicated acute suppurative otitis media, single-dose intramuscular ceftriaxone or 3- to 5-day short-course oral antimicrobial therapy should be effective in the majority (80%) of patients. However, more research is clearly needed in the subpopulations of children <2 years of age and in those with unresponsive/recurrent disease, since short-course therapy may not be successful in the majority of these patients.

In sinusitis, most short-course therapy data have involved maxillary disease in adult patients. Regimens have included 3 days of azithromycin or cotrimoxazole (trimethoprim/sulfamethoxazole) or 5 days of cefpodoxime, telithromycin, gatifloxacin, gemifloxacin or amoxicillin/clavulanic acid. Preliminary results are encouraging but more study is clearly needed, especially in the paediatric population.

In acute bacterial exacerbations of chronic bronchitis, short-course therapy with a variety of cephalosporins, second-generation fluoroquinolones and advanced generation macrolides/azalides/ketolides are all reasonable alternatives to traditional 7- to 14-day therapies.

Cost containment in antimicrobial therapy should involve consideration of short-course therapy in the management of the most common types of respiratory tract infections.

Keywords: Antibacterials, therapeutic use; Respiratory tract infections, treatment; Streptococcal infections, treatment; Children; Tonsillopharyngitis, treatment

Document Type: Research article

Affiliations: 1: Department of Experimental and Clinical Pharmacology and Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA

Publication date: 2003-01-01

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