What is considered premature discontinuation of antibiotics (Antibacterial therapy)?

From the Guidelines

Premature discontinuation of antibiotics is considered stopping the treatment before completing the full prescribed course, typically within 7 to 10 days, depending on the infection type and clinical response, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1.

Definition and Risks

Premature discontinuation of antibiotics refers to stopping an antibiotic treatment before completing the full prescribed course, even when symptoms have improved. This can lead to incomplete eradication of bacteria, allowing surviving organisms to multiply and potentially develop resistance.

• The 2016 Surviving Sepsis Campaign guidelines suggest that an antimicrobial treatment duration of 7 to 10 days is adequate for most serious infections associated with sepsis and septic shock 1.
• However, the guidelines also recommend daily assessment for de-escalation of antimicrobial therapy in patients with sepsis and septic shock 1, which may lead to shorter or longer courses of treatment depending on the patient's clinical response.

Clinical Considerations

When considering the discontinuation of antibiotics, healthcare providers should take into account the patient's clinical response, the presence of undrainable foci of infection, bacteremia with Staphylococcus aureus, and immunologic deficiencies, including neutropenia 1.

• The use of procalcitonin levels can support shortening the duration of antimicrobial therapy in sepsis patients 1, but this should be done under the guidance of a healthcare provider.
• Patients should be advised to complete the full prescribed course of antibiotics, even if symptoms have improved, to prevent antibiotic resistance and ensure complete recovery.

Management of Side Effects

If side effects occur, patients should contact their healthcare provider rather than stopping medication on their own, as they may suggest alternatives or ways to manage side effects while completing treatment.

• The 2016 Surviving Sepsis Campaign guidelines recommend against sustained systemic antimicrobial prophylaxis in patients with severe inflammatory states of noninfectious origin 1, highlighting the importance of judicious use of antibiotics.

From the FDA Drug Label

When azithromycin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of the therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by azithromycin or other antibacterial drugs in the future.

Premature discontinuation of antibiotics is considered to be skipping doses or not completing the full course of therapy as directed by a physician. This can lead to decreased effectiveness of the treatment and increased likelihood of bacterial resistance. 2

From the Research

Definition of Premature Discontinuation of Antibiotics

Premature discontinuation of antibiotics, also known as stopping antibiotics early, refers to the practice of ceasing antibiotic treatment before the completion of the prescribed course [ 3 ].

Factors Influencing Premature Discontinuation

Several factors can influence the decision to discontinue antibiotics prematurely, including:

• The type and severity of the infection being treated [ 4 ]
• The patient's individual risk profile and prior antibiotic treatment [ 4 ]
• The spectrum of pathogens and antibiotic susceptibility [ 4 ]
• The proven efficacy of the antibiotic [ 4 ]
• The ecological adverse effects (collateral damage) of antimicrobial therapy [ 4 ]

Studies on Premature Discontinuation

Several studies have investigated the effects of premature discontinuation of antibiotics, including:

• A randomized clinical trial that found 7 days of antibiotic treatment to be noninferior to 14 days for the treatment of urinary tract infections in afebrile men [ 5 ]
• A multicenter, noninferiority trial that found antibiotic treatment for 7 days to be noninferior to treatment for 14 days for the treatment of bloodstream infections [ 6 ]
• A review of systematic reviews that found short-course antibiotics to be as effective as longer courses for most common infections managed in ambulatory care [ 7 ]

Considerations for Premature Discontinuation

When considering premature discontinuation of antibiotics, the following factors should be taken into account:

• The potential risks and benefits of stopping antibiotics early [ 3 ]
• The need for unambiguous advice and shared decision making [ 3 ]
• The importance of personalized advice and consideration of individual patient factors [ 3 ]