From the Research
Patients should ideally discontinue antibiotics 48-72 hours before hospital admission to minimize the risk of opportunistic infections, though this timeframe should be balanced against the patient's current infection needs. This recommendation applies to non-essential antibiotics that were prescribed for conditions that have resolved or are improving. Common antibiotics that should be discontinued include amoxicillin, azithromycin, ciprofloxacin, and doxycycline. However, patients with active infections, immunocompromised status, or those on prophylactic antibiotics for specific conditions should continue their prescribed regimens. The rationale behind this recommendation is that antibiotic use disrupts the normal protective microbiome, potentially allowing opportunistic pathogens like Clostridioides difficile to proliferate, as suggested by studies on the impact of antibiotic use on the microbiome 1, 2.
Some key points to consider when deciding to discontinue antibiotics include:
- The patient's current infection status and whether the infection has resolved or is improving
- The patient's immunocompromised status and whether they are at increased risk of opportunistic infections
- The specific antibiotic being used and its potential impact on the microbiome
- The potential risks and benefits of continuing or discontinuing antibiotic treatment, as discussed in studies on antibiotic stewardship 3, 4
It's also important to note that probiotics may have a role in reducing the risk of opportunistic infections, particularly in patients who are at high risk of developing these infections 5. However, more research is needed to fully understand the potential benefits and risks of using probiotics in this context. Ultimately, the decision to discontinue antibiotics should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, and in consultation with the prescribing physician.