But what is actually the correct length of treatment for all the different antibiotics and diseases? How many ward rounds on ICU’s have I spent with microbiologists (the maybe most important specialists on our sides!) wondering on how they always had a straight answer on the correct length of treatment. 7 days, 10 days or sometimes 21 days… a little mystery to most intensivists, until now!
Hitchhiking though the the wide space of the internet I finally found secret to this question. Back in the year 2010 Paul E. Sax, a Professor of Medicine at Harvard Medical School him self, posted an excellent blog for the NEJM Journal Watch website. Inspired by a New York Time article by Harvard Professor Daniel Gilbert he finally gave insight into one of the great mysteries of medicine:
To figure out how long antibiotics need to be given, use the following rules:
- Choose a multiple of 5 (fingers of the hand) or 7 (days of the week).
- Is it an outpatient problem that is relatively mild? If so, choose something less than 10 days. After application of our multiples rule, this should be 5 or 7 days.
- Is it really mild, so much so that antibiotics probably aren’t needed at all but clinician or patient are insistent? Break the 5/7 rule and go with 3 days. Ditto uncomplicated cystitis in young women.
- Is it a serious problem that occurs in the hospital or could end up leading to hospitalization? With the exception of community-acquired pneumonia (5 or 7 days), 10 days is the minimum.
- Patient not doing better at the end of some course of therapy? Extend treatment, again using a multiple of 5 or 7 days.
- Does the infection involve a bone or a heart valve? Four weeks (28 days) at least, often 6 weeks (42 days). Note that 5 weeks (35 days) is not an option — here the 5′s and 7′s cancel each other out, and chaos ensues.
- The following lengths of therapy are inherently weird, and should generally be avoided: 2, 4, 6, 8, 9, 11, 12, 13 days. Also, 3.14159265 days.
In this highly data-driven exercise, it is imporant also to note the number of rules — seven, as in days of the week.
That did not occur by chance
Wow, not much more I can add!