[Medscape] Guidelines for short-term antibiotic prescribing (ACP, 2021)


Guidelines for the appropriate use of short-term antibiotics in common infections were published in April 2021 by the American College of Medicine in Internal Medicine.

Chronic obstructive pulmonary disease and uncomplicated bronchitis

If a patient with uncomplicated chronic obstructive pulmonary disease and acute bronchitis shows signs of bacterial infection, such as increased sputum production, along with dyspnea and/or increased sputum volume, then treat with antibiotics. should be limited to a period of 5 days.

Antibiotic selection is based on the most common bacterial causes, including Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.

Recommended therapeutic agents include aminopenicillin with clavulanic acid, macrolides, and tetracyclines.

Community pneumonia

The minimum duration of antibiotic treatment for community-acquired pneumonia is 5 days. Any extension of antibiotic therapy beyond 5 days should be based on clinically validated measures of stability; These measures include (1) stable vital signs (2) ability to eat and (3) psychological stability.

Antibiotic selection is based on the most common bacterial etiology, including S pneumoniae, H influenzae, Mycoplasma pneumoniae, and Staphylococcus aureus, along with atypical pathogens (eg, Legionella).

Recommended therapeutic agents include amoxicillin, doxycycline, or macrolides in healthy adults or in patients with comorbidities, beta-lactams with macrolides, or inhalation fluoroquinolones.

Urinary tract infections

In men or women with uncomplicated pyelonephritis, a short course of antibiotic therapy with a fluoroquinolone (5-7 days) or trimethoprim-sulfamethoxazole (14 days) is recommended, based on antibiotic susceptibility.

In women with uncomplicated bacterial cystitis, a short course of antibiotics with nitrofurantoin (5 days), trimethoprim-sulfamethoxazole (3 days), or fosfomycin (single dose) is recommended.


For nonpurulent cellulitis, 5 to 6 days of antibiotic therapy with activity against streptococcal species (eg, cephalosporins, penicillin, clindamycin); this is especially relevant for patients who are able to self-monitor and for those receiving close monitoring by primary care.

These recommendations do not apply to patients with purulent cellulitis (eg, abscess, boil, boil) or suspected methicillin-resistant S aureus (MRSA) infection.

For more information, you can visit the following pages:

Chronic Obstructive Pulmonary Disease (COPD)


Community-Acquired Pneumonia (CAP)

Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females

Urinary Tract Infection (UTI) in Males



  1. Lee RA, Centor RM, Humphrey LL, Jokela JA, Andrews R, Qseem A. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Ann Intern Med. 2021 Apr 6. Available at: https://www.acpjournals.org/doi/10.7326/M20-7355.
  2. Haelle T. New Guidelines on Antibiotic Prescribing Focus on Shorter Courses. Medscape Medical News. April 5, 2021. Available at: https://www.medscape.com/viewarticle/948754.

Source: Short-Course Antibiotic Prescribing Clinical Practice Guidelines (ACP, 2021)

Translator: Kim Luan

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