Segment Description: Monica V. Mahoney, PharmD, BCPS (AQID), BCIDP, clinical pharmacy specialist of outpatient ID clinics/OPAT clinic in the Department of Pharmacy at Beth Israel Deaconess Medical Center, and Contagion®’s In the Literature Section Editor, discusses how shorter courses of therapy are just as effective as longer courses of therapy.
Interview transcript: (modified slightly for readability)
Shorter is better is a nice catchphrase, [but] I think the more appropriate term is shorter is just as effective as longer therapy. In the past couple of years, we've had more studies coming out not looking at a specific drug or a specific indication, but looking at all drugs, or a collection of drugs, a particular drug class, being used for a particular infection. In the newest update of the HABP/VABP guidelines, we went from the 2005-2006 HABP/VABP guidelines that said you can do 7 to 8 days of therapy unless they're non-fermenters so things like Pseudomonas, Syntrophomonas, Acinetobacter, well maybe we can treat those for 2 weeks.
In the 2016 version, they said, “you know what? No, 7 days for all patients; it doesn't matter what organism is causing their HABP/VABP.” They went back, and they did their own analysis and they found that there was no difference in relapse or mortality. So why shouldn't we treat for shorter in these patients?
Additionally, with febrile neutropenia we've had a number of studies we've had the How Long Study, we've had the ANTIBIOSTOP study that have been looking at rather than waiting for patients who are febrile neutropenic and don't have an identifiable source of infection. Do we need to wait until they have neutrophil recovery which can be weeks or months? Can we treat them until they're a febrile for 2 days for 3 days regardless of ANC and then peel back? Studies are showing that they probably do just as fine as the ones that we have for longer durations. Just last week there was an article that was released looking at male patients with UTIs or pyelonephritis—you know how long are we treating them and that study concluded that 7 days is just as good as longer.
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