\u201cOne of the most universally accepted beliefs around the world,\u201d said Brad Spellberg, MD, chief medical officer at Los Angeles General Medical Center, \u201cis that when you take antibiotics, you must complete the prescribed course \u2014 7, 10, or 14 days \u2014 even after you start feeling better, in order to eliminate every last bacterium and prevent a future relapse.\u201d<\/p>\n
\u201cBut that recommendation doesn\u2019t make sense. There\u2019s no data to support it,\u201d Spellberg noted in a virtual lecture<\/a> at the 2025 Argentine Society of Infectious Diseases Congress, held in Mar del Plata from June 12 to 14.<\/p>\n \u201cThat\u2019s not how antibiotics work. Every additional day you take an antibiotic increases resistance,\u201d he emphasized.<\/p>\n Spellberg cited two quotes from Louis Rice, MD, chair of the Department of Medicine at the Warren Alpert Medical School of Brown University, Providence, Rhode Island, and former president of the Infectious Diseases Society of America:<\/p>\n \u201cWe should tell patients: \u2018If you\u2019re taking antibiotics, and you feel better but still have a few days left, call me, and we\u2019ll decide whether to stop,\u2019\u201d Spellberg advised.<\/p>\n He added that if you prescribe 14 days of antibiotics for an infection, the patient is still taking them for a week after symptoms resolve. \u201cBut if you prescribe 5-7 days, stopping early isn\u2019t a problem. So, we can resolve everything simply by switching to short-course therapy.\u201d<\/p>\n \u2018Shorter Is Better\u2019<\/strong><\/p>\n Spellberg\u2019s stance isn\u2019t new. A decade ago, he coined the mantra \u201cshorter is better<\/a>,\u201d challenging the dogma that longer antibiotic regimens are more effective \u2014 a notion since disproven by dozens of clinical trials. As he told Medscape\u2019s Spanish edition<\/a> in 2016, \u201cProviding short antibiotic courses based on evidence reduces the risk that patients will feel better before completing therapy and minimizes leftover pills.\u201d<\/p>\n He reported that over 150 randomized controlled trials across 24 infection types have demonstrated that short antibiotic courses yield the same clinical outcomes as longer ones. For example, in cases of community-acquired pneumonia, 14 studies have shown that 3-5 days of antibiotic therapy are as effective as 5-14 days. Similarly, for urinary tract infections or pyelonephritis, 13 studies indicate that 5-7 days of treatment are just as effective as 10-14 days. In intra-abdominal infections, three studies have found that 4 days of antibiotics are comparable in efficacy to 8-10 days of treatment.<\/p>\n\n