question: why are anti-biotics prescribed over 10 days?
comment: Because not all bacteria die at once when you take a pill. It is important to really really kill all of them, because bacterial growth is very fast. When you stop after 99 % are killed the infection will come back quickly. Building up AB resistance is also a problem, why you want to strike hard on bacteria.
passages: "Initial Treatment for Acute Bacterial Skin Infections (ABSSSI) Caused by Staphylococcus aureus" "Randomized, Dose Ranging, Active Controlled Efficacy and Safety Evaluation of PMX-30063 As Initial Treatment for Acute Bacterial Skin and Skin Structure Infections (ABSSSI) Caused by Staphylococcus aureus"
   Prior to the early 1990s, it was common practice for the physician performing the procedure to prescribe an antibiotic to take for a few days to prevent an infection. Since that time, many urologists will order a "urine C & S" (urinalysis with bacterial/fungal cultures and testing for sensitivities to anti-infective medications) prior to the performance of the cystoscopy, and as part of the pre-operative workup. Depending on the results of the testing and other circumstances, he or she may elect to prescribe a 10- to 14-day course of antibiotic or other anti-infective treatment, commencing 3 days before the cystoscopy is to be performed, as this may alleviate some inflammation of the urethra prior to the procedure. This practice may provide an additional benefit by preventing an accidental infection from occurring during the procedure. The full-course of antibiotic treatment also lessens the possibility of the bacteria becoming resistant to the antibiotic/anti-infective agent prescribed.
   The clinical trial was successful, demonstrating safety and clinical efficacy for all evaluated doses of brilacidin, with three-day brilacidin cure rates of all dosing regimens comparable with seven days of Daptomycin. The results indicated the potential for a shorter brilacidin dosing regimen. Shorter dosing regimens are important as they reduce the risks from Intravenous therapy complications, reduce costs such as reduced hospital stays and clinic visits, and can help reduce the emergence of antibiotic resistance through a combination of a quick bacterial kill, shorter duration of treatment, and increased patient compliance. As patients may feel better before treatment is complete and discontinue treatment too early, this is a risk for their health and also the development of antibiotic resistance. A single one day dosage eliminates the risk of patient non-compliance.
   Once daily dosing of aminoglycoside is sufficient to achieve peak plasma concentration for clinical response without kidney toxicity. Meanwhile, for antibiotics with low volume distribution (vancomycin, teicoplanin, colistin), loading dose is required to achieve adequate therapeutic level to fight infections. Frequent infusions of beta-lactam antibiotics without exceeding total daily dose would help to keep the antibiotics level above minimum inhibitory concentration (MIC), thus providing better clinical response. Giving beta-lactam antibiotics continuously may be better than giving them intermittently. Access to therapeutic drug monitoring is important to ensure adequate drug therapeutic level while at the same time preventing the drug from reaching toxic level.
   Section::::Prevention.:Limiting antibiotic use.:At the hospital level.
  
  Antimicrobial stewardship teams in hospitals are encouraging optimal use of antimicrobials. The goals of antimicrobial stewardship are to help practitioners pick the right drug at the right dose and duration of therapy while preventing misuse and minimizing the development of resistance. Stewardship may reduce the length of stay by an average of slightly over 1 day while not increasing the risk of death.
  
  Section::::Prevention.:Limiting antibiotic use.:At the farming level.
   Antibiotic resistance increases with duration of treatment. Therefore, as long as an effective minimum is kept, shorter courses of antibiotics are likely to decrease rates of resistance, reduce cost, and have better outcomes with fewer complications. Short course regimens exist for community-acquired pneumonia spontaneous bacterial peritonitis, suspected lung infections in intense care wards, so-called acute abdomen, middle ear infections, sinusitis and throat infections, and penetrating gut injuries. In some situations a short course may not cure the infection as well as a long course. A BMJ editorial recommended that antibiotics can often be safely stopped 72 hours after symptoms resolve.
   There are many different routes of administration for antibiotic treatment. Antibiotics are usually taken by mouth. In more severe cases, particularly deep-seated systemic infections, antibiotics can be given intravenously or by injection. Where the site of infection is easily accessed, antibiotics may be given topically in the form of eye drops onto the conjunctiva for conjunctivitis or ear drops for ear infections and acute cases of swimmer's ear. Topical use is also one of the treatment options for some skin conditions including acne and cellulitis. Advantages of topical application include achieving high and sustained concentration of antibiotic at the site of infection; reducing the potential for systemic absorption and toxicity, and total volumes of antibiotic required are reduced, thereby also reducing the risk of antibiotic misuse. Topical antibiotics applied over certain types of surgical wounds have been reported to reduce the risk of surgical site infections. However, there are certain general causes for concern with topical administration of antibiotics. Some systemic absorption of the antibiotic may occur; the quantity of antibiotic applied is difficult to accurately dose, and there is also the possibility of local hypersensitivity reactions or contact dermatitis occurring.
   Safety is a major factor in the efficacy of microbial drug delivery. Depending on the type of drug being administered, a certain level of control is required for effective and safe treatment of colonic diseases. The "L. lactis" system has a 72-hour delay between ingesting thymidine and activating IL-10 production, while the "B. ovatus" system allows the drug to be produced once xylan reaches the bacteria. Regarding IL-10 secretions in "L. lactis", the delay is acceptable for treatment of IBD, however any drug that requires a precise dosage and timing may necessitate "B. ovatus" for controlling drug output.
   A course of one week of antibiotics is usually sufficient to treat the condition. However, if the condition recurs, antibiotics can be given in a cyclical fashion in order to prevent tolerance. For example, antibiotics may be given for a week, followed by three weeks off antibiotics, followed by another week of treatment. Alternatively, the choice of antibiotic used can be cycled.
  
  The condition that predisposed the patient to bacterial overgrowth should also be treated. For example, if the bacterial overgrowth is caused by chronic pancreatitis, the patient should be treated with coated pancreatic enzyme supplements.
   Postinfection treatment involves a combination of antituberculosis antibiotics, including rifampicin, rifabutin, ciprofloxacin, amikacin, ethambutol, streptomycin, clarithromycin or azithromycin.
  
  NTM infections are usually treated with a three-drug regimen of either clarithromycin or azithromycin, plus rifampicin and ethambutol. Treatment typically lasts at least 12 months.
  
  Although studies have not yet identified an optimal regimen or confirmed that any therapeutic regimen produces sustained clinical benefit for patients with disseminated MAC, the Task Force concluded that the available information indicated the need for treatment of disseminated MAC. The Public Health Service therefore recommends that regimens be based on the following principles:
   Professional guidelines therefore recommend the commencement of dexamethasone or a similar corticosteroid just before the first dose of antibiotics is given, and continued for four days. Given that most of the benefit of the treatment is confined to those with pneumococcal meningitis, some guidelines suggest that dexamethasone be discontinued if another cause for meningitis is identified. The likely mechanism is suppression of overactive inflammation.
   Antibiotic treatment duration should be based on the infection and other health problems a person may have. For many infections once a person has improved there is little evidence that stopping treatment causes more resistance. Some therefore feel that stopping early may be reasonable in some cases. Other infections, however, do require long courses regardless of whether a person feels better.
  
  Section::::Prevention.:Monitoring and mapping.
  
  There are multiple national and international monitoring programs for drug-resistant threats, including methicillin-resistant "Staphylococcus aureus" (MRSA), vancomycin-resistant "S. aureus" (VRSA), extended spectrum beta-lactamase (ESBL), vancomycin-resistant "Enterococcus" (VRE), multidrug-resistant "A. baumannii" (MRAB).
   Section::::Empiric antibiotic therapy.
  
  Empiric antibiotic therapy refers to the use of antibiotics to treat a suspected bacterial infection despite lack of a specific bacterial diagnosis. Definitive diagnosis of the species of bacteria often occurs through culture of blood, sputum, or urine, and can be delayed by 24 to 72 hours. Antibiotics are generally given "after" the culture specimen has been taken from the patient in order to preserve the bacteria in the specimen and ensure accurate diagnosis. Alternatively, some species may be identified through a urine or stool test.
  
  Section::::Empiric antibiotic therapy.:Selection of appropriate treatment.
   Several factors determine the most appropriate choice for the initial antibiotic regimen. These factors include local patterns of bacterial sensitivity to antibiotics, whether the infection is thought to be a hospital or community-acquired infection, and which organ systems are thought to be infected. Antibiotic regimens should be reassessed daily and narrowed if appropriate. Treatment duration is typically 7–10 days with the type of antibiotic used directed by the results of cultures. If the culture result is negative, antibiotics should be de-escalated according to person's clinical response or stopped altogether if infection is not present to decrease the chances that the person is infected with multiple drug resistance organisms. In case of people having high risk of being infected with multiple drug resistance organisms such as "Pseudomonas aeruginosa", "Acinetobacter baumannii", addition of antibiotic specific to gram-negative organism is recommended. For Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin or teicoplanin is recommended. For Legionella infection, addition of macrolide or fluoroquinolone is chosen. If fungal infection is suspected, an echinocandin, such as caspofungin or micafungin, is chosen for people with severe sepsis, followed by triazole (fluconazole and itraconazole) for less ill people. Prolonged antibiotic prophylaxis is not recommended in people who has SIRS without any infectious origin such as acute pancreatitis and burns unless sepsis is suspected.
   BULLET::::- Hospitalized patients without risk for "pseudomonas": This group requires intravenous antibiotics, with a quinolone active against "streptococcus pneumoniae" (such as levofloxacin), a β-lactam antibiotic (such as cefotaxime, ceftriaxone, ampicillin/sulbactam or high-dose ampicillin plus a macrolide antibiotic (such as azithromycin or clarithromycin) for seven to ten days.
   High-dose antibiotics are administered by the intravenous route to maximize diffusion of antibiotic molecules into vegetation(s) from the blood filling the chambers of the heart. This is necessary because neither the heart valves nor the vegetations adhering to them are supplied by blood vessels. Antibiotics are typically continued for two to six weeks depending on the characteristics of the infection and the causative microorganisms.
   Antibiotics are not prescribed for patients to control viral infections. They may however be prescribed to a flu patient for instance, to control or prevent bacterial secondary infections. They also may be used in dealing with air-borne bacterial primary infections, such as pneumonic plague.
   Treatment guidelines call for the administration of broad-spectrum antibiotics within the first hour following recognition of septic shock. Prompt antimicrobial therapy is important, as risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. Time constraints do not allow the culture, identification, and testing for antibiotic sensitivity of the specific microorganism responsible for the infection. Therefore, combination antimicrobial therapy, which covers a wide range of potential causative organisms, is tied to better outcomes. Antibiotics should be continued for 7–10 days in most patients, though treatment duration may be shorter or longer depending on clinical response.
   Incubation times vary based upon the microbe that requires culturing. Traditional culturing techniques, for example, require less than 24 hours culture time for "Escherichia coli" but 6–8 weeks for successful culturing of "Mycobacterium tuberculosis" before definitive results are expressed. A benefit of non-culture tests is that physicians and microbiologists are not handicapped by waiting periods.
   Cultures should be taken before treatment when indicated and treatment potentially changed based on the susceptibility report.
  
  About a third of antibiotic prescriptions written in outpatient settings in the United States were not appropriate in 2010 and 2011. Doctors in the U.S. wrote 506 annual antibiotic scripts for every 1,000 people, with 353 being medically necessary.
  
  Health workers and pharmacists can help tackle resistance by: enhancing infection prevention and control; only prescribing and dispensing antibiotics when they are truly needed; prescribing and dispensing the right antibiotic(s) to treat the illness.
  
  Section::::Prevention.:Limiting antibiotic use.:At the individual level.
   Antibiotic creams are the preferred treatment for mild cases of impetigo, despite their limited systemic absorption. Such prescribed ointments include neosporin, fusidic acid, chloramphenicol and mupirocin. More severe cases of impetigo however (especially bullous impetigo) will likely require oral agents with better systemic bioavailability, such as cephalexin. Cases that do not resolve with initial antibiotic therapy or require hospitalization may also be indicative an MRSA infection, which would require the use of agents specifically able to treat it, such as clindamycin.
   Empiric antibiotics are usually initiated as soon as the diagnosis of NSTI has been made, and then later changed to culture-guided antibiotic therapy. In the case of NSTIs, empiric antibiotics are broad-spectrum, covering gram-positive (including MRSA), gram-negative, and anaerobic bacteria.
  
  While studies have compared moxifloxacin (a fluoroquinolone) and amoxicillin-clavulanate (a penicillin) and evaluated appropriate duration of treatment (varying from 7 to 21 days), no definitive conclusions on the efficacy of treatment, ideal duration of treatment, or the adverse effects could be made due to poor-quality evidence.
  
  Section::::Treatment.:Add on therapy.
   So,
  
  means isoniazid, rifampicin, ethambutol, pyrazinamide daily for two months, followed by four months of isoniazid and rifampicin given three times a week.
  
  In the US only, streptomycin is no longer considered a first line drug by ATS/IDSA/CDC because of high rates of resistance. The WHO have made no such recommendation.
  
  Section::::Drugs.:Second line.
   There are many factors that affect physicians’ compliance with guideline recommendations, including cultural factors, educational background, training, nurse and pharmacist influences, medication supply, and logistics.[3]
  
  For dental procedures, the American protocol in 2017 called for the prescription of amoxicillin or ampicillin.
  
  Section::::For humans.:Advantages of long-acting antibiotics.
  
  Long-acting, broad-spectrum antibiotics offer the following advantages by comparison to short-acting antimicrobials in perioperative prophylaxis:
  
  BULLET::::- A single dose covers the whole perioperative risk period - even if the operation is delayed or long-lasting - and with regard to respiratory and urinary tract infections
   It may not always be necessary to treat with four drugs from the beginning. An example might be a close contact of a patient known to have a fully sensitive strain of tuberculosis: in this case, it is acceptable to use 2HRZ/4HR (omitting EMB and STM) in the expectation that their strain will be INH susceptible also. Indeed, this was previously the recommended standard regimen in many countries until the early 1990s, when isoniazid-resistance rates increased.
  