• Neil Powell, Jennie Stephens, Rory Rule, Ryan Phillips, Megan Morphew, Emma Garry, Natasha Askaroff, Daniel Hiley, Charlie Strachan, Myles Sheehan, and Caitlin McDonald.
• Royal Cornwall Hospital Trust, Treliske, UK and honorary clinical school fellow, University of Plymouth, Plymouth, UK neil.powell2@nhs.net.
• Clin Med (Lond). 2021 Jan 1; 21 (1): e39e44e39-e44.

IntroductionAntibiotic use drives antibiotic resistance. Reducing antibiotic use through reducing antibiotic course lengths could contribute to the UK national ambition to reduce total antibiotic use.MethodsMedical notes were reviewed for patients who had received at least 5 days of antibiotic therapy; had been discharged in January 2019; and were from a 750-bed acute secondary care hospital in England. UK national guidelines were used to determine the excess antibiotic use in common medical infections: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), pyelonephritis, cellulitis, infective exacerbation of chronic obstructive pulmonary disease (IECOPD) and cholangitis.ResultsFour-hundred and twenty-three patients met the inclusion criteria. Of these, 307 (73%) patient notes were retrieved and reviewed. One-hundred and seventy-three patients met the study case definitions, of which, 137 met short course criteria.Potential antibiotic reductions (measured in defined daily doses) were identified for five of the six infections: 32% in CAP, 20% in HAP, 14% in IECOPD, 11% in cellulitis and 10% in pyelonephritis. These reductions were estimated to reduce total antibiotic use in medical specialties by 12.4%, which equates to 3.6% of the hospital's total antibiotic use.ConclusionClinical application of the evidence-based guidance for shorter antibiotic course lengths appears to be a valid strategy for reducing total antibiotic consumption.© Royal College of Physicians 2021. All rights reserved.

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