Adherence to therapy, treatment success, and the prevention of resistance

The importance of patient adherence to antimicrobial chemotherapy regimens has long been recognized in chronic diseases such as tuberculosis and HIV. There is now growing evidence that patient completion of therapy is important in acute diseases such as bacterial respiratory tract infection. Recent epidemiologic surveys have documented the rising rates of resistance in key respiratory tract pathogens including Streptococcus pneumoniae and Haemophilus influenzae. Use of antimicrobials is a major cause for the selection of resistance and is dependent on the class and dose of the antimicrobial used, in addition to the duration of therapy. Short-course, high-dose antibiotic regimens are effective, and patients are more likely to complete the therapy as prescribed. Short-course, high-dose antibiotic regimens were also associated with decreased selection of short-term resistance compared with longer courses of the same antibiotics administered at lower daily doses.