Inappropriate antibiotic duration in common infections: Are we treating habits rather than evidence?

Dear Editor,

Antibiotics remain among the most frequently prescribed medications in clinical practice, yet their duration of use often reflects habit rather than evidence. For many common and uncomplicated infections, including community acquired pneumonia, urinary tract infection, uncomplicated gram negative bacteremia, and uncomplicated intra abdominal infection, randomized trials have consistently demonstrated that shorter courses are as effective as longer ones in achieving clinical cure.^1,2 Despite this, prolonged antibiotic therapy remains widespread in both inpatient and outpatient settings. Prescribing patterns are often influenced by tradition, fear of relapse, or the assumption that more treatment ensures better outcomes. The disconnection between evidence and practice thus contributes to unnecessary drug exposure and has important public health implications. Excessive antibiotic duration increases the risk of adverse drug reactions, promotes antimicrobial resistance (AMR), and is associated with secondary infections such as Clostridioides difficile colitis.³ In an era where AMR threatens the effectiveness of modern medicine, continued reliance on outdated prescribing norms undermines global stewardship efforts.

Addressing inappropriate antibiotic duration requires deliberate changes at both the individual and health system levels. Clear guideline recommendations now endorse shorter courses for many infections, yet awareness and implementation remain inconsistent.^1,4 Education alone is insufficient unless reinforced by practical tools that support decision making at the point of care. Incorporating default stop dates into electronic prescribing systems, requiring documentation of planned duration, and encouraging early clinical reassessment can help normalize shorter courses. Antimicrobial stewardship programs have demonstrated that audit and feedback, particularly when delivered by infectious disease physicians or pharmacists, can safely reduce antibiotic duration without compromising patient outcomes.² Equally important is patient education, as expectations for longer antibiotic courses may pressure clinicians to continue therapy beyond what is necessary. Emphasizing clinical stability rather than arbitrary time frames allows therapy to be tailored to individual response, reinforcing that resolution of symptoms and objective improvement are better indicators of treatment success than completion of a predetermined number of days.

In conclusion, inappropriate antibiotic duration in common infections represents a modifiable gap between evidence and everyday practice. Persisting with longer courses offers no additional benefit for most patients and exposes both individuals and health systems to avoidable harm. Aligning antibiotic duration with contemporary evidence requires a shift away from tradition toward stewardship driven care supported by guidelines, systems based interventions, and shared understanding between clinicians and patients. Shortening antibiotic courses when clinically appropriate is not undertreatment but rather an essential step toward preserving antibiotic effectiveness for the future.