Ethics of Antibiotic Course Duration: Shorter is Better

Antibiotic treatment course duration has for decades been dictated by two questionable ideas: first, that longer courses are more effective at curing bacterial infections; second, that longer courses are less likely to lead to drug resistance. Recently, the "shorter is better" movement has challenged the received wisdom, showing shorter-duration antibiotic courses provide similar cure rates, fewer antibiotic-related harms, and possibly less contribution to of antibiotic resistance for common infections. Yet, physicians typically still prescribe longer courses of antibiotics than clinical guidelines recommend. This is ethically unacceptable. In this paper, we argue that prescribing physicians are ethically obligated to prescribe shorter antibiotic courses, given that prescribing physicians bear duties both toward their patients and to protect public health. We rebut objections to our argument and furthermore argue for an ethical obligation of physician-researchers to conduct further trials comparing the shortest current evidence-based course of antibiotics with courses that are even shorter.