From the Guidelines
You should not stop taking prescribed antibiotics before entering the hospital, as stopping them prematurely can lead to incomplete treatment of infections and potentially contribute to antibiotic resistance. When considering the management of antibiotics in the context of hospital admission, it's crucial to prioritize the completion of the prescribed antibiotic course to ensure effective treatment of the underlying infection and minimize the risk of antibiotic resistance. The decision to continue, modify, or discontinue antibiotic therapy should be made by the hospital medical team based on your condition and the reason for hospitalization, taking into account the most recent and highest quality evidence available 1. Key considerations include:
- The type and severity of the infection being treated
- The specific antibiotic prescribed and its duration of use
- The patient's clinical response to the antibiotic therapy
- The potential for antibiotic resistance and the need for antimicrobial stewardship
- The importance of informing the hospital medical team about your current medication regimen, including the specific antibiotic, dosage, start date, and the reason it was prescribed, to ensure coordinated care 1. By following these guidelines and considering the latest evidence, healthcare providers can optimize antibiotic use, improve patient outcomes, and reduce the risk of antibiotic resistance.
From the Research
Duration of Antibiotic Therapy
- The optimal duration of antimicrobial treatment is unknown, but there is growing evidence that reducing the length of antibiotic courses to 7-8 days can minimize the consequences of antibiotic overuse in critical care, including antibiotic resistance, adverse effects, collateral damage, and costs 2.
- Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) can help guide antibiotic duration, but should be interpreted cautiously in the context of the clinical situation 2.
Stopping Antibiotics Before Hospital Admission
- There is no specific guideline on how long to be off antibiotics before entering the hospital, as it depends on the individual clinical situation and the type of infection being treated.
- However, it is recommended to stop antibiotics when not needed, and to keep the antibiotic course as short as possible to minimize the risk of antibiotic resistance and other adverse effects 2, 3.
Factors Influencing Antibiotic Discontinuation
- Hospital prescribers are more likely to continue antibiotics when discontinuation would conflict with local guidelines, when presenting symptoms clearly indicate antibiotics, and when patients have severe frailty or comorbidities 4.
- Guidelines that conflict with antibiotic discontinuation, such as pre-specifying fixed durations, may discourage safe discontinuation at review, while guidelines conditional on patient factors or treatment response could help hospital prescribers discontinue antibiotics if diagnostic information suggests they are no longer needed 4.
Alternative Treatments
- Faecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (CDI), with an overall clinical effect of 91% following repeat FMT and 84% following single FMT 5.
- FMT may be a safer alternative to vancomycin for treating recurrent CDI, with a superior number needed to treat (NNT) compared to antibiotics 6, 5.