Shorter Is Better: Rethinking Antibiotic Duration for Respiratory Infections in the Fight Against Antimicrobial Resistance

Antimicrobial resistance (AMR) poses a growing global health threat, with inappropriate antibiotic use identified as a key driver. This retrospective cross-sectional study examined antibiotic prescribing patterns for respiratory tract infections (RTIs) among 640 adult inpatients at a UK NHS Foundation Trust across 2019 and 2020. The research evaluated the effectiveness of shorter (≤5 days) versus longer (6–7 days and >8 days) antibiotic courses in the treatment of common respiratory infections, including COPD exacerbations, COVID-19 pneumonia, and hospital-acquired pneumonia. Findings revealed that shorter antibiotic durations were equally effective in most cases, with 82.9% of patients discharged following ≤5-day regimens. Prolonged antibiotic use (>8 days) was associated with longer hospital stays (p < 0.01) without added benefit. However, a non-significant trend towards higher mortality was noted in the short-duration group, warranting further investigation. The study supports international efforts, including Public Health Ontario’s “Shorter is Smarter” campaign, to promote shorter antibiotic courses as part of antimicrobial stewardship (AMS) strategies. Recommendations include incorporating patient-specific risk assessment and local guideline updates to ensure effective and safe antibiotic use. These findings offer critical insights for optimising treatment, reducing resistance, and advancing global AMS goals.