Short-Course antimicrobial therapy for upper respiratory tract infections.
OBJECTIVE
This review examines the issues surrounding short-course antimicrobial therapy of group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis, acute (suppurative) otitis media, and acute sinusitis.


BACKGROUND
Accumulating evidence suggests that short-course (ie, < or = 5 days) antimicrobial therapy may have equivalent or superior efficacy compared with traditional longer (10- to 14-day) therapies.


RESULTS
In GABHS tonsillopharyngitis, short-course therapy with 6 days of amoxicillin, 4 or 5 days of various cephalosporins, and 5 days of azithromycin (10 mg/kg once daily on all 5 days in pediatric patients) are all reasonable alternatives to traditional 10-day penicillin therapy. In uncomplicated acute (suppurative) otitis media, single-dose intramuscular ceftriaxone or 3- to 5-day short-course oral antimicrobial therapy should be effective in > or = 80% of patients. However, more research is needed in children aged <2 years, since short-course therapy may not be successful in most patients in this population. In sinusitis, most short-course therapy data have involved acute maxillary disease in adult patients. Preliminary results are encouraging, but more study is needed, especially in children.


CONCLUSIONS
Cost-containment in antimicrobial therapy should include consideration of short-course therapy in the management of upper respiratory tract infections.
Institute for the Study of Geriatric Pharmacotherapy, University of Minnesota, College of Pharmacy, and PartneringCare Senior Services, HealthPartners, Minneapolis 55455, USA. guayx001@tc.umn.edu
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Guay
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D006801:Humans; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology
D000890:Anti-Infective Agents