WEBVTT
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Welcome to Boomer versus Truth.
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This is a bonus mailback episode where we answer one listener question outside of our regular full episodes.
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And we're dropping this as a separate bonus so our main episodes stay focused and clean.
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Uh and keep in mind, no CE is available for this episode.
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Yep.
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And this one came through our send us fan mail audio option.
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So let's hear from our listener.
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Love the show, first time caller.
00:00:42.240 --> 00:00:46.719
Real quick question, this might be low stakes, but would be interested to hear your thoughts.
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And that's, you know, we keep shortening the duration of antibiotics from 10 to 7 to 5 to even three days in some cases.
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And at what point can patients or can patients just stop taking antibiotics when they start feeling better?
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Thank you.
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Well, that was cool getting to hear an audience member.
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But let's walk through the practical answer here quickly and clearly.
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I was actually able to follow up with our episode guest, Dr.
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Madeline King, to get her thoughts on this.
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So let's see what she had to say.
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Welcome back, Dr.
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King.
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Thank you for coming back to help us again with yet another claim regarding stewardship.
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Uh, one of our audience members asked, uh, does stopping antibiotics early uh when patients feel better, does that lead to resistance?
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What do you think about that?
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Really good question.
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Um, thinking about stopping antibiotics early.
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So one of the reasons that we do shorter courses is that what we found and um studied over the past couple of decades is you know, shorter courses lead to less resistance because we're not exposing all of the microbiome to antibiotics for a prolonged period of time.
00:01:55.599 --> 00:02:02.159
So in general, a shorter course is going to be better for the patient in terms of leading to resistance.
00:02:02.480 --> 00:02:03.599
Yeah, that's a great point.
00:02:03.680 --> 00:02:07.920
And I'm kind of curious, where then are all these durations we hear about coming from?
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Like how are we just throwing darts at a dartboard and seeing what sticks?
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Where are these, where, where do we get these ideas on durations?
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Yeah, I I would love to say that they're not entirely made up.
00:02:19.759 --> 00:02:23.199
Um, and if you go back to an article from uh Dr.
00:02:23.360 --> 00:02:33.919
Paul Sachs from like 2010, kind of a parody article, he talks about how we get five days from the number of fingers you have on one hand and seven days from the number of days in one week.
00:02:34.080 --> 00:02:37.680
Um, and it actually kind of feels like that's where we got durations from.
00:02:37.840 --> 00:02:44.960
Um, and it may be where we started back when antibiotics were first being used 80 years ago.
00:02:45.199 --> 00:02:54.639
However, we do have a lot of actual evidence and literature over the past few decades that compares short to long courses of antibiotics.
00:02:54.800 --> 00:03:07.599
Um so we've used that literature to kind of base our guidelines on how to treat these infections, showing, you know, if five versus seven days you have no difference in outcomes, then we're going to recommend five days in our guidelines.
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Great.
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So we know that shorter courses have good outcomes, don't lead to resistance, but longer durations don't necessarily help with resistance, like we always used to be taught.
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Um, but what do we have to think about before we have patients maybe stop antibiotics when they're feeling better?
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Any stipulations to think about there?
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Yeah, that's a great question.
00:03:30.400 --> 00:03:37.120
Um, you know, none of the guidelines on treating these infections say tell your patient if they feel better after three days to go ahead and stop.
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Um, because we're not studying that.
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So we can't say that that's the right thing to do.
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Um, however, you know, if someone has a urinary tract infection and we give three to five days of antibiotics, um, if they're feeling better in two to three days, should they stop?
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It's probably fine.
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Um, should they call their provider and say, I'm feeling better, I'd like to stop a day early, that's acceptable.
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But we all know it's hard to get in touch with providers that quickly.
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Um, so I think it is really hard to tell patients, hey, stop as soon as you're feeling better.
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Um, but what we really want to think about is what is the risk?
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So, what's the risk of stopping early just because you feel better?
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Is the risk recurrence or is the risk that um, you know, the infection isn't totally gone and symptoms are going to restart because it never actually went away?
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Um and we don't really have anything supporting any of that.
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So I think for the most part, um, the best way to go is to educate providers on these shorter courses and let providers know, hey, you can really treat this infection with only five days of antibiotics instead of seven.
00:04:40.319 --> 00:04:52.319
Um and, you know, in certain cases, if they feel um very comfortable with the patient themselves and the infection they're treating, they could tell the patient, hey, if you're feeling better in a few days, go ahead and stop.
00:04:52.480 --> 00:04:56.800
I don't know that this antibiotic needs to be continued for seven or ten days.
00:04:56.959 --> 00:05:05.680
Um, so I think it really should at this point still be coming from the provider to stop those antibiotics earlier than the duration that's prescribed.
00:05:05.839 --> 00:05:10.800
Um, but we may get to a point where we feel comfortable saying, hey, as soon as you start feeling better, go ahead and stop.
00:05:11.120 --> 00:05:12.800
Yeah, we'll see what the research says.
00:05:12.879 --> 00:05:15.279
And regardless, it takes a patient-centered approach.
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I love that.
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Exactly.
00:05:17.519 --> 00:05:18.800
Thank you for describing that.
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And I'll bring that back to Don and see what he thinks.
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But thanks again for all your help.
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That's great.
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Thanks for having me.
00:05:28.399 --> 00:05:30.240
Glad we can have her back on the show for this.
00:05:30.319 --> 00:05:39.839
Uh, so the short takeaway is stopping early may be an option in some cases, but this decision should be up to the prescriber while talking with the patient.
00:05:40.319 --> 00:05:49.360
And patients should generally have completed at least the minimum duration here for a given infection, uh, such as three days instead of five for community acquired pneumonia.
00:05:49.920 --> 00:05:50.160
Yeah.
00:05:50.800 --> 00:05:53.199
So thanks for listening to this bonus mailbag.
00:05:53.360 --> 00:05:56.399
Keep sending questions through the link in the show notes or email.
00:05:56.959 --> 00:06:02.720
And we'll be back with our next full episode on Gabapentin, C included, coming soon on May 19th.
00:06:02.800 --> 00:06:03.920
We'll see you then.
00:00:12.160 --> 00:00:14.160
Welcome to Boomer versus Truth.
00:00:14.240 --> 00:00:20.239
This is a bonus mailback episode where we answer one listener question outside of our regular full episodes.
00:00:20.640 --> 00:00:25.519
And we're dropping this as a separate bonus so our main episodes stay focused and clean.
00:00:25.679 --> 00:00:29.039
Uh and keep in mind, no CE is available for this episode.
00:00:29.280 --> 00:00:29.679
Yep.
00:00:29.839 --> 00:00:34.159
And this one came through our send us fan mail audio option.
00:00:34.320 --> 00:00:36.320
So let's hear from our listener.
00:00:39.759 --> 00:00:41.920
Love the show, first time caller.
00:00:42.240 --> 00:00:46.719
Real quick question, this might be low stakes, but would be interested to hear your thoughts.
00:00:46.880 --> 00:00:54.399
And that's, you know, we keep shortening the duration of antibiotics from 10 to 7 to 5 to even three days in some cases.
00:00:54.640 --> 00:01:00.799
And at what point can patients or can patients just stop taking antibiotics when they start feeling better?
00:01:01.119 --> 00:01:02.000
Thank you.
00:01:02.560 --> 00:01:05.680
Well, that was cool getting to hear an audience member.
00:01:05.760 --> 00:01:09.920
But let's walk through the practical answer here quickly and clearly.
00:01:10.079 --> 00:01:12.959
I was actually able to follow up with our episode guest, Dr.
00:01:13.040 --> 00:01:14.799
Madeline King, to get her thoughts on this.
00:01:15.120 --> 00:01:16.799
So let's see what she had to say.
00:01:20.319 --> 00:01:21.599
Welcome back, Dr.
00:01:21.760 --> 00:01:22.079
King.
00:01:22.239 --> 00:01:26.400
Thank you for coming back to help us again with yet another claim regarding stewardship.
00:01:26.560 --> 00:01:33.680
Uh, one of our audience members asked, uh, does stopping antibiotics early uh when patients feel better, does that lead to resistance?
00:01:33.840 --> 00:01:35.280
What do you think about that?
00:01:36.079 --> 00:01:37.120
Really good question.
00:01:37.200 --> 00:01:39.920
Um, thinking about stopping antibiotics early.
00:01:40.079 --> 00:01:55.439
So one of the reasons that we do shorter courses is that what we found and um studied over the past couple of decades is you know, shorter courses lead to less resistance because we're not exposing all of the microbiome to antibiotics for a prolonged period of time.
00:01:55.599 --> 00:02:02.159
So in general, a shorter course is going to be better for the patient in terms of leading to resistance.
00:02:02.480 --> 00:02:03.599
Yeah, that's a great point.
00:02:03.680 --> 00:02:07.920
And I'm kind of curious, where then are all these durations we hear about coming from?
00:02:08.080 --> 00:02:11.759
Like how are we just throwing darts at a dartboard and seeing what sticks?
00:02:11.919 --> 00:02:14.879
Where are these, where, where do we get these ideas on durations?
00:02:15.680 --> 00:02:19.599
Yeah, I I would love to say that they're not entirely made up.
00:02:19.759 --> 00:02:23.199
Um, and if you go back to an article from uh Dr.
00:02:23.360 --> 00:02:33.919
Paul Sachs from like 2010, kind of a parody article, he talks about how we get five days from the number of fingers you have on one hand and seven days from the number of days in one week.
00:02:34.080 --> 00:02:37.680
Um, and it actually kind of feels like that's where we got durations from.
00:02:37.840 --> 00:02:44.960
Um, and it may be where we started back when antibiotics were first being used 80 years ago.
00:02:45.199 --> 00:02:54.639
However, we do have a lot of actual evidence and literature over the past few decades that compares short to long courses of antibiotics.
00:02:54.800 --> 00:03:07.599
Um so we've used that literature to kind of base our guidelines on how to treat these infections, showing, you know, if five versus seven days you have no difference in outcomes, then we're going to recommend five days in our guidelines.
00:03:07.919 --> 00:03:08.240
Great.
00:03:08.400 --> 00:03:19.280
So we know that shorter courses have good outcomes, don't lead to resistance, but longer durations don't necessarily help with resistance, like we always used to be taught.
00:03:19.520 --> 00:03:25.840
Um, but what do we have to think about before we have patients maybe stop antibiotics when they're feeling better?
00:03:26.080 --> 00:03:28.000
Any stipulations to think about there?
00:03:28.879 --> 00:03:30.240
Yeah, that's a great question.
00:03:30.400 --> 00:03:37.120
Um, you know, none of the guidelines on treating these infections say tell your patient if they feel better after three days to go ahead and stop.
00:03:37.280 --> 00:03:38.960
Um, because we're not studying that.
00:03:39.039 --> 00:03:41.520
So we can't say that that's the right thing to do.
00:03:41.759 --> 00:03:51.759
Um, however, you know, if someone has a urinary tract infection and we give three to five days of antibiotics, um, if they're feeling better in two to three days, should they stop?
00:03:51.840 --> 00:03:53.280
It's probably fine.
00:03:53.439 --> 00:03:59.360
Um, should they call their provider and say, I'm feeling better, I'd like to stop a day early, that's acceptable.
00:03:59.520 --> 00:04:02.879
But we all know it's hard to get in touch with providers that quickly.
00:04:03.039 --> 00:04:08.080
Um, so I think it is really hard to tell patients, hey, stop as soon as you're feeling better.
00:04:08.240 --> 00:04:11.840
Um, but what we really want to think about is what is the risk?
00:04:12.000 --> 00:04:16.000
So, what's the risk of stopping early just because you feel better?
00:04:16.160 --> 00:04:24.720
Is the risk recurrence or is the risk that um, you know, the infection isn't totally gone and symptoms are going to restart because it never actually went away?
00:04:24.879 --> 00:04:27.600
Um and we don't really have anything supporting any of that.
00:04:27.839 --> 00:04:40.000
So I think for the most part, um, the best way to go is to educate providers on these shorter courses and let providers know, hey, you can really treat this infection with only five days of antibiotics instead of seven.
00:04:40.319 --> 00:04:52.319
Um and, you know, in certain cases, if they feel um very comfortable with the patient themselves and the infection they're treating, they could tell the patient, hey, if you're feeling better in a few days, go ahead and stop.
00:04:52.480 --> 00:04:56.800
I don't know that this antibiotic needs to be continued for seven or ten days.
00:04:56.959 --> 00:05:05.680
Um, so I think it really should at this point still be coming from the provider to stop those antibiotics earlier than the duration that's prescribed.
00:05:05.839 --> 00:05:10.800
Um, but we may get to a point where we feel comfortable saying, hey, as soon as you start feeling better, go ahead and stop.
00:05:11.120 --> 00:05:12.800
Yeah, we'll see what the research says.
00:05:12.879 --> 00:05:15.279
And regardless, it takes a patient-centered approach.
00:05:15.360 --> 00:05:15.839
I love that.
00:05:16.720 --> 00:05:17.120
Exactly.
00:05:17.519 --> 00:05:18.800
Thank you for describing that.
00:05:18.879 --> 00:05:20.879
And I'll bring that back to Don and see what he thinks.
00:05:20.959 --> 00:05:22.240
But thanks again for all your help.
00:05:22.800 --> 00:05:23.360
That's great.
00:05:23.439 --> 00:05:24.319
Thanks for having me.
00:05:28.399 --> 00:05:30.240
Glad we can have her back on the show for this.
00:05:30.319 --> 00:05:39.839
Uh, so the short takeaway is stopping early may be an option in some cases, but this decision should be up to the prescriber while talking with the patient.
00:05:40.319 --> 00:05:49.360
And patients should generally have completed at least the minimum duration here for a given infection, uh, such as three days instead of five for community acquired pneumonia.
00:05:49.920 --> 00:05:50.160
Yeah.
00:05:50.800 --> 00:05:53.199
So thanks for listening to this bonus mailbag.
00:05:53.360 --> 00:05:56.399
Keep sending questions through the link in the show notes or email.
00:05:56.959 --> 00:06:02.720
And we'll be back with our next full episode on Gabapentin, C included, coming soon on May 19th.
00:06:02.800 --> 00:06:03.920
We'll see you then.
