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Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients
Hannah Imlay1, Brad Spellberg2
1Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
Background:
Prolonged antibiotics are associated with toxicity, selection for resistant organisms, and secondary infections such as Clostridioides difficile colitis. Emerging clinical data suggest that short courses of antibiotics can be used for common bacterial infections among immune competent patients, but for many randomized controlled trials (RCTs), immunocompromised patients, including solid organ transplant recipients (SOTRs), have been excluded.
Methods:
Peer-reviewed publications were identified through PubMed and Embase searches.
Results:
We review data examining shorter antibiotic courses among immunocompetent and immunocompromised patients and the rationale for use of short antibiotic courses in SOTRs.
Conclusion:
There are known harms associated with antibiotics and, when studied, existing data do not demonstrate harm associated with shorter courses of antibiotics among SOTRs. Furthermore, several RCTs did include some immune compromised patients and found shorter therapy to result in similar clinical efficacy with diminished adverse effects. Shorter antibiotic durations should be considered in SOTRs, and questions of antibiotic duration among SOTRs should be prioritized for study in clinical trials.
Insights
Shorter antibiotic courses are safe and effective for solid organ transplant recipients (SOTRs), reducing harms like C. difficile colitis. Prioritizing research into optimal antibiotic durations for SOTRs is crucial for improved patient outcomes.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Pharmacology
Background:
- Prolonged antibiotic use carries risks including toxicity, antimicrobial resistance, and secondary infections like Clostridioides difficile colitis.
- While short antibiotic courses show promise in immunocompetent individuals, immunocompromised patients, including solid organ transplant recipients (SOTRs), are often excluded from trials.
Purpose of the Study:
- To review existing data on shorter antibiotic courses in both immunocompetent and immunocompromised patients.
- To examine the rationale and evidence for using short antibiotic courses specifically in SOTRs.
Main Methods:
- Systematic review of peer-reviewed publications.
- Literature search conducted using PubMed and Embase databases.
Main Results:
- Data suggest shorter antibiotic courses are not associated with harm in SOTRs.
- Randomized controlled trials including some immunocompromised patients indicate similar clinical efficacy with fewer adverse effects for shorter antibiotic durations.
Conclusions:
- Shorter antibiotic durations should be considered for SOTRs due to established antibiotic harms.
- Clinical trials should prioritize investigating optimal antibiotic durations for SOTRs to improve safety and efficacy.
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