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Antimicrobials are drugs that kill or prevent the growth of bacteria, viruses, fungi, or parasites. Antimicrobials can be life-saving therapies for patients with serious infections.  For patients who do not have infections, antimicrobials are not helpful and increase the likelihood of developing antimicrobial resistance and patient harm.  Antimicrobial stewardship programs including the Carolina Antimicrobial Stewardship Program help ensure patients with infections get the right drug, at the right dose, for the right length of time, or duration.

Too often, patients with common infectious syndromes such as urinary tract infections, pneumonia, and skin and soft tissue infections receive longer-than-needed antimicrobial treatment when a shorter duration would be equally effective.

Antimicrobial resistance is a top global public health threat, including here in the US. When an antimicrobial is no longer effective because of resistance, healthcare teams have fewer options to treat patients.  Today, some pathogens are impossible to treat with existing antimicrobials. Such infections are regularly seen at UNC Hospitals.   Currently, there are not enough new antimicrobials in development to replace the ones that no longer work.  In the future, many people could die of common infections, as they did before the antimicrobials were invented.  Antimicrobial stewardship is one way healthcare providers can help slow resistance.

Shorter Durations:

    Have fewer side effects and complications

      May lead to shorter hospital stays, lower costs, and improved patient adherence

    May slow antimicrobial resistance, keeping these life-saving drugs effective for longer

Experts at the UNC Medical Center Carolina Antimicrobial Stewardship Program developed Best Practices for Durations of Antimicrobial Therapy to aid patient care teams as they select the best care for their patients.

Each of us can be an antimicrobial steward. One important way for nurses, pharmacists, and prescribers to practice stewardship is by knowing, using, and promoting shorter antimicrobial durations whenever possible.

Common Questions

Antimicrobials are drugs that prevent the growth of or kill bacteria, viruses, fungi, or parasites. Antibiotics are one type of antimicrobial that only work against bacteria. Today we have a wide range of antibiotics effective against various types of bacteria, but we need to be careful to preserve the effectiveness of these therapies in light of growing bacterial resistance.
Each time a person takes an antimicrobial, all of the bacteria and fungi that reside in and around the human body is exposed to the antimicrobial–these include the pathogen responsible for an infection but also the billions of other helpful bacteria and fungi. During each antimicrobial exposure, there is a chance for organisms to change during their reproductive cycle. These changes may allow it to survive when faced with a medicine that would typically inhibit its growth or kill it.
Most bacterial resistance is due to selection of resistant bacteria within a population. Antimicrobials kill only the susceptible pathogens, leaving resistant organisms behind, which can then thrive and increase in number without the competition from susceptible strains. Different drugs may then be needed to kill the resistant organisms.

Today, some pathogens are very hard or impossible to treat with existing antimicrobials. Such infections are present here in North Carolina and have been seen at UNC Medical Center. When an antimicrobial is no longer effective, healthcare teams have fewer tools available to treat infections.

Antimicrobial use is correlated to antimicrobial exposure. Since each antimicrobial exposure provides an opportunity for selection of resistant organisms or for acquisition of new resistance due to changes during the organism’s reproductive cycle, shorter durations reduce overall exposure and selective pressure. It is important that antimicrobials are used effectively, meaning the duration is appropriate to treat the patient’s infection–it is not in the interest of antimicrobial stewardship to use less effective durations because that can lead to relapse, ultimately leading to the need for repeated antimicrobial courses.
Prescribers are responsible for defining antimicrobial courses for their patients. Knowing and applying the shortest, appropriate duration for an infection is the number one way prescribers can contribute to the Shorter. Safer. Better. campaign. Check out the CASP Durations of Therapy Best Practices and start using this tool to guide decisions on durations. Prescribers can also include this information in counseling patients and caregivers, attach the campaign badge to their email signature, and ask peers to join the campaign effort as well.
Pharmacists are responsible for verifying orders for antimicrobial courses. They may also participate in multidisciplinary patient care rounds and counsel patients and caregivers on antimicrobial therapy. Knowing the shortest, appropriate duration for an infection and asking about courses that are longer than recommended is a great way for pharmacists to contribute to decision-making on antimicrobial durations. Pharmacists can also include information related to anticipated duration of therapy in counseling patients and caregivers.
Nurses are key members of the healthcare team. Noting the intended duration of antimicrobial therapy can help counsel patients and caregivers, and asking about longer-than-expected durations can help the patient care team.
Yes! Each of us has a role to play. While CASP’s current focus is on people who prescribe and review antimicrobial prescriptions, other UNC Medical Center colleagues are encouraged to sign on.


Print and share the Shorter. Safer. Better. flyer.

Examples of Shorter. Safer. Better. In Action

Acute Bronchitis

Situation: A 35-year-old patient with acute bronchitis presents to an outpatient clinic.

Intervention: Because of acute bronchitis cases are viral, no antibiotics are prescribed. The provider recommends rest and fluid at home and symptomatic therapies, knowing the condition will resolve on its own in a few weeks.

Message: Antibiotics do not help people who do not have bacterial infections and may cause harm and contribute to antimicrobial resistance. Providers can direct patients to therapies that provide symptomatic relief.

Learn More

Urinary Tract Infection

Situation: A four-year-old female patient is admitted for pyelonephritis. Urine culture is obtained and appropriate empirical therapy is begun. Once susceptibilities of the uropathogen are known, therapy is targeted and converted to oral.

Intervention: The American Academy of Pediatrics recommends that pyelonephritis should be treated for 7-10 days. Recent literature suggests that shorter courses of 6-9 days are as effective as longer courses of 10+ days. Caution is required when there are significant functional or anatomic abnormalities of the urinary tract.

Message: Duration of therapy for pyelonephritis and other urinary tract infections differs based on infection type and the patient’s urologic status. Use of narrow spectrum agents for the shortest effective durations is Shorter. Safer. Better. in action.

Learn More about Pediatric UTI Learn about Adolescent & Adult UTI

Community-Acquired Pneumonia

Situation: A 65-year-old patient presents to the Emergency Department with community-acquired pneumonia (CAP).

Intervention: Providers initiate appropriate empirical antimicrobial therapy based on the patient’s specific risks and clinical status. When the patient is afebrile and has no more than one clinical sign of instability, antimicrobial therapy is transitioned to the oral route and a total course of five days (including days of IV and oral therapy) is planned.  Therapy can be targeted if a specific pathogen is found.

Message: CAP is a common infection, but specific pathogens are not frequently found. The best way to balance the chances of benefit and harm from antimicrobial therapy is to use the shortest effective duration.

Learn about Adult CAP Learn More about Pediatric CAP


Stewards in Action

Antimicrobial stewards across the UNC Medical Center are taking the pledge and using or encouraging colleagues to use the shortest effective durations.