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Am Fam Physician. 2022;105(2):205-206

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• In patients with COPD exacerbations, antibiotic courses should be limited to five days.

• In patients with community-acquired pneumonia, the initial antibiotic course should be limited to five days with follow-up before completion of the course.

• For women with uncomplicated bacterial cystitis, taking nitrofurantoin for five days, trimethoprim/sulfamethoxazole for three days, or a single dose of fosfomycin is effective.

• In patients with uncomplicated pyelonephritis, taking a fluoroquinolone for five to seven days is the most effective empiric treatment.

From the AFP Editors

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.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, associate medical editor.

A collection of Practice Guidelines published in AFP is available at

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