Antibiotics – shorter courses (5 days) are better (pneumonia and cellulitis)

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Antibiotics – shorter courses (5 days) are better (pneumonia and cellulitis

A JAMA editorial1 comments on a trial of 5 versus 10 days of antibiotics for patients hospitalised with community-acquired pneumonia2. After 5 days of antibiotic treatment, patients were randomised to either continuing antibiotics, or stopping antibiotics (if afebrile for 48 hours and no more than 1 sign of clinical instability such as hypotension, tachycardia, tachypnoea or hypoxia).  The shorter duration group did better at 30 days. 

Equivalence has also been shown for cellulitis with 5 versus 10 days of antibiotics.3 “There is no evidence that taking antibiotics beyond the point at which a patient’s symptoms are resolved reduces antibiotic resistance”. 

Prolonged antibiotic treatment may instead cause “increased selective pressure driving antibiotic resistance among our colonising microbial flora.”1

This Gem has been checked by Associate Professor Mark Thomas, Infectious Disease Physician Auckland City Hospital and the University of Auckland.


  1. Spellberg B. The New Antibiotic Mantra “Shorter is Better". JAMA Intern Med 2016. Click here
  2. Uranga  A, España  PP, Bilbao  A,  et al.  Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial JAMA Internal Med 2016. Click here
  3. Hepburn MJ et al., Comparison of Short-Course (5 Days) and Standard (10 Days) Treatment for Uncomplicated Cellulitis. Arch Intern Med 2004. Click here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

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As published in NZ Doctor 15/02/2017