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VCU physician argues for short-course antibiotic therapy in New England Journal of Medicine editorial

Doctors should prescribe shorter antibiotic treatment courses for patients recovering from abdominal sepsis surgery, according to a study published in this week’s issue of the New England Journal of Medicine. The study’s assertions are supported with experiential evidence in an editorial published in the same issue, which is co-written by Richard “Dick” P. Wenzel, M.D., professor emeritus and former chairman, Department of Internal Medicine, Virginia Commonwealth University School of Medicine.

The editorial analyzes findings from the Study to Optimize Peritoneal Infection Therapy trial of short-course antimicrobial therapy for abdominal sepsis. Abdominal sepsis is an infection in one of the organs located in the abdominal cavity, such as the appendix, intestine or pancreas. Treatment with antibiotics is required to eradicate the infection. However, the appropriate duration of postsurgical antibiotic therapy has heretofore been unclear. 

In the study, researchers found that treating patients with antibiotics for four days was as effective as treating them for an average of eight days. Citing the study for support, Wenzel argues that shorter antibiotic courses are more desirable to minimize drug-related adverse events, the selection of antibiotic resistance and costs.

“All antibiotics have side effects and they all cost money,” Wenzel said. “Additionally, the more antibiotics you give, the more you are going to create resistant organisms. If it is safe, four days sounds a whole lot better than eight days.”

Wenzel estimates that approximately 1.2 million days of antibiotic therapy could be saved annually in the U.S. if the standard treatment regime was reduced. In a table included in the editorial, Wenzel estimates that the reduction in days translates to more than $97 million less spent on antibiotics per year.

Antibiotic-related side effects such as diarrhea and vein inflammation could also be reduced with shorter treatment courses. “Even if you could prevent a quarter of those side effects, that’s thousands of people who won’t have problems,” Wenzel said.

The editorial, titled “Antibiotics for Abdominal Sepsis,” appears in the May 21 issue of the journal.

About VCU and VCU Medical Center

Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located in downtown Richmond, VCU enrolls more than 31,000 students in 226 degree and certificate programs in the arts, sciences and humanities. Sixty-seven of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 13 schools and one college. MCV Hospitals and the health sciences schools of Virginia Commonwealth University comprise VCU Medical Center, one of the nation’s leading academic medical centers. For more, see www.vcu.edu.

Richard “Dick” P. Wenzel, M.D.
Richard “Dick” P. Wenzel, M.D.