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4 new ACP advice statements

for antibiotic use in India

M3 India Newsdesk Jun 03, 2021

The American College of Physicians

has shared their best practices
regarding the use of antibiotics
for common bacterial illnesses in
patients. This article throws light on
how it is crucial and need of the hour to
adopt these practices in India.
The ACP's best practice advice
on the use of short-term
antibiotics in common
infections

Antibiotic resistance is exacerbated by

antimicrobial misuse, which is a serious
health concern. Antibiotics are
overused in patients with common
bacterial illnesses such as acute
bronchitis with chronic obstructive
pulmonary disease (COPD)
exacerbation, community-acquired
pneumonia (CAP), urinary tract
infections (UTIs), and cellulitis for
unduly extended periods of time. The
best practices for providing effective
and short-term antibiotic treatment for
individuals with various illnesses are
described in this article. The American
College of Physicians has issued
guidance titled 'Appropriate Use of
Short-Course Antibiotics in Common
Infections: American College of
Physicians Best Practice Advice'.

Four best-practice advice

statements by ACP

ACP has issued four particular best

practice advice statements, each with
brief remarks from the guidelines.

The justification for ACP antibiotic

guidance: At least 30% of the 250
million antibiotic courses provided in
2014 were deemed unnecessary, and
many of the regimens were excessively
lengthy. Antibiotic-resistant infections
are recognised as a "national threat" by
both the ACP and the Centers for
Disease Control and Prevention.

Appropriate antibiotic use has

been defined by the ACP: Prescribe
the appropriate antibiotic, at the
appropriate dose, for the appropriate
period, for a particular ailment. The goal
of this best practice guideline is to
indicate when shorter periods of
antibiotic therapy are suitable for
common bacterial illnesses observed in
both inpatient and outpatient health
care settings.

Best practice recommendation

#1

COPD exacerbation and acute

bronchitis:
When treating patients with COPD
exacerbations or acute uncomplicated
bronchitis who exhibit clinical symptoms
of bacterial infection (increased sputum
purulence in addition to increased
dyspnoea and/or increased sputum
volume), clinicians should restrict
antibiotic therapy duration to five days.

Acute uncomplicated bronchitis is often

self-limiting and viral in nature. The
ACP does not suggest antibiotics until
pneumonia is evident. Antibiotics are
suggested for COPD due to the high
pretest chance of bacterial causation.
The Global Strategy for the Prevention,
Diagnosis and Management of COPD
(GOLD) recommendations advocate
the use of antibiotics in the presence of
clinical symptoms of bacterial
infection. Antibiotic selection should be
based on the most frequent infections.
Exacerbation of COPD treatment:

Haemophilus influenzae, Streptococcus

pneumoniae, and Moraxella catarrhalis
are the most frequently reported
bacterial pathogens. A combination of
aminopenicillin and clavulanic acid, a
macrolide, or tetracycline may be used
to treat the infection.

Best practice recommendation

#2

Community-acquired pneumonia:

Clinicians should administer antibiotics

for a minimum of five days to treat
community-acquired pneumonia (CAP).
Extending antibiotic therapy beyond five
days should be guided by proven
clinical stability indicators, such as
remission of vital sign abnormalities,
capacity to eat, and normal mentation.

Empirical therapy should include both

common infections, such as
Streptococcus pneumoniae and
Haemophilus influenzae, as well as
atypical infections, such as Legionella
species.

Shorter-duration antibiotic treatment is

supported by evidence. Antibiotics for
at least 5 days are recommended by
the 2019 Infectious Disease Society of
America (IDSA)/American Thoracic
Society (ATS) recommendation for the
management of CAP.

Best practice recommendation

#3

UTI- uncomplicated cystitis and

pyelonephritis

Clinicians should provide short-course

antibiotics to women with simple
bacterial cystitis, such as nitrofurantoin
for 5 days, trimethoprim-
sulfamethoxazole (TMP–SMZ) for 3
days, or fosfomycin as a single dose.
Clinicians should recommend short-
course treatment with fluoroquinolones
(5–7 days) or TMP–SMZ (14 days) for
men and women with uncomplicated
pyelonephritis based on antibiotic
susceptibility.

1. UTI uncomplicated cystitis:

Infectious cystitis is a typical
reason for healthy women to take
 antibiotics. Use empirical
antibiotics to target
Escherichia coli, which accounts
for more than 75% of all bacterial
cystitis. Fluoroquinolones are
quite efficient in 3-day regimens,
but they have a significant risk of
side effects; do not administer
them indiscriminately. Save them
for patients who have resistant
pathogens.
2. UTI pyelonephritis: The
IDSA/European Society of Clinical
Microbiology and Infectious
Diseases (ESCMID) 2011
recommendations are the basis
for the current treatment duration
recommendation. There was no
significant difference in clinical
failure with fluoroquinolones in
more recent data on shorter-
 course treatment.

Best practice recommendation

#4

Cellulitis:

Clinicians should utilise a 5- to 6-day

course of antibiotics active against
streptococci in patients with non-
purulent cellulitis, particularly in those
who are able to self-monitor and have
close follow-up with primary care.

Treatment recommendations:
Cephalosporin, penicillin, or
clindamycin, unless in individuals with
further symptoms of MRSA, MRSA
nasal colonisation, injectable drug
usage, or systemic inflammatory
reaction syndrome. Include an
additional antimicrobial agent that is
effective against MRSA and
streptococci.

India- The centre of

antimicrobial resistance
catastrophe

Antibiotic abuse is widespread in India's

private sector, particularly among
children aged 0-4 years, new research
showed. Inappropriate antibiotic
prescription and usage is frequently the
primary cause of antimicrobial
resistance, which is an increasing
problem not only in India but
internationally. Antibiotic resistance is a
worldwide problem.
However, India is the epicentre of this
disaster. The country is affected by
easy access to the strongest antibiotics
without prescriptions or diagnoses by
trained physicians, not only quacks who
administer medications without
consideration but by hospitals where
abuse has resulted in the establishment
of colonies of these superbugs.
Excessive antibiotic use on living
creatures and inadequate sanitation
has created an ideal environment for
these super-resistant microorganisms
to pose a threat to our health. The
American College of Physicians' best
practice advice on the use of short-term
antibiotics in common infections is the
need of the hour for India.

Disclaimer- The views and opinions

expressed in this article are those of the
author's and do not necessarily reflect
the official policy or position of M3
India.

The author is a practising super

specialist from New Delhi.

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