Antimicrobial overuse leads to more than 2.6 million illnesses and 35,900 deaths annually. Of the more than 250 million courses of antibiotics prescribed in the United States in 2014, at least 30% were considered unnecessary. There is no evidence that longer courses of antibiotics reduce antibiotic resistance in bacterial illness. Instead, longer courses appear to increase antibiotic resistance through natural selection. After reviewing clinical guidelines, systematic reviews, and individual studies, the American College of Physicians (ACP) has released recommendations for common antibiotic prescribing situations in primary care.

COPD Exacerbations

In chronic obstructive pulmonary disease (COPD) exacerbations, antibiotic courses should be limited to five days.

In patients with acute bronchitis, defined as respiratory symptoms with normal chest radiography, antibiotics are indicated only when the patient has COPD and is suspected to have a bacterial cause as indicated by increased sputum purulence and dyspnea or increased sputum volume. In COPD exacerbations, oral treatment with amoxicillin/clavulanate (Augmentin), a macrolide, or a tetracycline has been proven effective and covers the likely pathogens Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.