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More than half of all patients receive at least one antimicrobial agent during their hospital stay. At the Medical Center as with other facilities, patients sometimes receive treatment that is longer than needed for common infections. Reducing unnecessary antimicrobial exposure is essential to preserving the efficacy of these drugs for the future.

Shorter durations are better for patients and better for slowing antimicrobial resistance

Carolina Antimicrobial Stewardship Program’s David Weber, MD, MPH and Ashley Marx, PharmD developed the Best Practices for Durations of Antimicrobial Therapy  in 2020 with extensive review from adult and pediatric infectious diseases clinicians. The best practices serve as a quick reference for evidence-based durations for common infections such as lower respiratory, urinary tract, and skin and soft tissue. They are intended to complement clinical judgment.

The shortest effective durations of antimicrobial therapy are both better for patients and for slowing antimicrobial resistance alike. “Clinical trials conducted in recent years have found short courses to be equally effective compared to longer courses for many types of infections,” said Lindsay Daniels, PharmD, MPH, CASP’s pharmacy lead. “Shorter courses reduce the risk of adverse effects, limit disruption of the microbiome, and decrease the risk of selecting for antibiotic-resistant organisms.”

While too-long durations may lead to problems, too-short therapy can also be a problem. Too-short durations can lead to relapse, ultimately leading to the need for repeated antimicrobial courses.

Handle antimicrobials with care

To mark World Antimicrobial Awareness Week, CASP is conducting a pledge campaign to encourage UNC Medical Center colleagues to know, use, and share the shortest effective durations of antimicrobial therapy. Since the Shorter. Safer. Better. campaign kicked off at the end of October, more than 200 UNC Medical Center colleagues have pledged, and more than double that number have viewed the best practices. Udobi Campbell, PharmD, MBA, executive director of pharmacy, Triangle West region; Tom Ivester, MD, MPH, chief medical officer, UNC Medical Center; and Jeff Strickler, DHA, RN, interim chief nursing officer, UNC Medical Center, sponsor the campaign.

The pledge offers concrete actions that individuals can take to know, use, and promote the shortest effective durations. For example, colleagues may choose to educate their patients about the importance of the shortest effective durations; nurses may pledge to highlight prescriptions that have continued beyond seven days without specified duration to the prescriber or pharmacist.  Individuals not in patient care roles who care about antimicrobial resistance are also encouraged to pledge their support by helping spread the word.

The campaign concludes at the end of World Antimicrobials Awareness Week on November 24.