Stop Your Antibiotics When You Feel Like It

... a sunsetting of "finish the entire course" recommendations?

Usually, when antibiotics are prescribed, one of the classical recommendations has been: “make sure you finish the entire course as prescribed.”

But, what happens when you stop – as likely many do – once you feel better?

Well, since the vast majority of antibiotics are likely prescribed for viral infections, of course you keep getting better! But, in true bacterial infections – such as these febrile urinary tract infections studied here – there is a true risk for treatment failure.

In the INDI-UTI trial, an open-label trial from Denmark, fundamentally-well children with febrile UTI were randomized to either a “standard” 10-day course of antibiotics, or an “individualized” protocol. In the individualized protocol, antibiotics could be stopped 72 hours after complete resolution of infectious symptoms – fever, dysuria, and/or flank pain.

Main results are here:

You can see there are two, main competing outcomes: antibiotic days, which are obviously decreased; and recurrent UTI within 28 days, which are increased. A fair chunk of the recurrent UTIs in the “individualised” cohort came within a week of antibiotic discontinuation:

So, lessons here consistent with the rest of the literature showing shorter courses of antibiotics are appropriate for many conditions – but still a signal of a subset of patients needing to be identified for a longer course.