Shorter antibiotic courses show similar outcomes to longer use for some pneumonia patients
American College of Physicians
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Shorter antibiotic courses show similar outcomes to longer use for some pneumonia patients
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03538
Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00795
Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03538-PS
URL goes live when the embargo lifts
A multicenter target trial emulation found that for eligible patients hospitalized with community-acquired pneumonia (CAP), health outcomes were similar whether they received a three- to four-day course of antibiotics or a course lasting five days or more. The findings suggest that for a selected subset of patients with early clinical stability, shorter treatment durations may be just as safe and effective as traditional longer regimens. The study is published in Annals of Internal Medicine.
Researchers from the University of Texas Southwestern, University of Michigan Medical School, University of Utah School of Medicine, and colleagues sought to evaluate whether short antibiotic courses are safe for adults hospitalized with CAP who show early clinical stability. Researchers analyzed data from patients across 67 Michigan hospitals between 2017 and 2024 to compare outcomes for patients who received three to four days of antibiotics with those treated for five days or longer. Only 10% of patients met the strict criteria for short-course therapy, and among them, the study found no meaningful differences in mortality, readmissions, urgent care visits, or C. difficile infections. These findings suggest that shorter treatment may be appropriate for clinically stable patients. However, the small number of short-course cases warrants further study.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Valerie M. Vaughn, MD, MSc, please email Sophia Friesen at sophia.friesen@hsc.utah.edu.
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2. Experts debate the management of a patient with frequent migraine headaches
This “Beyond the Guidelines” feature is based on a Grand Rounds discussion held on 31 October 2025 at Beth Israel Deaconess Medical Center.
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00527
URL goes live when the embargo lifts
In a new Annals “Beyond the Guidelines” feature, a primary care physician and a neurologist discuss the management of a young woman with frequent migraine headaches. Their discussion is framed within the context of the 2025 International Headache Society (IHS) and American College of Physicians (ACP) guidelines for migraine pharmacotherapy, which differ in their recommendations for first‑line and escalation therapies.
The experts reviewed the case of Ms. D, a 27‑year‑old woman who has had migraine headaches since childhood. Her headaches occur 2 to 15 days per month, are often accompanied by nausea, photophobia, and phonophobia, and are triggered by sleep disruption, exercise, atmospheric pressure changes, and certain foods. Over the years, she has tried multiple acute treatments with only ubrogepant providing reliable benefit. Preventive therapies including propranolol, amitriptyline, nortriptyline, and monoclonal antibodies have yielded inconsistent or diminishing results. Botox previously helped but was interrupted when she moved. Her medical history includes irritable bowel syndrome, esophageal reflux disease, seasonal allergies, and hypercholesterolemia, and she uses estrogen-containing oral contraceptives.
The first discussant, Gerald W. Smetana, MD, is a Professor of Medicine, Emeritus, at Harvard Medical School and Beth Israel Deaconess Medical Center. Dr. Smetana emphasizes a structured, evidence-based approach to both acute and preventive treatment choices. He notes triptans remain highly effective for more severe episodes, while gepants offer an option for those who do not tolerate or respond to triptans. For Ms. D, he would continue ibuprofen and ubrogepant for acute management. For prevention, he favors topiramate, acknowledging its teratogenic risk and the need for contraception counseling. He views calcitonin gene-related peptide (CGRP) monoclonal antibodies as an important tool but agrees with ACP guidance to reserve them for patients who have not responded to traditional oral preventives. He underscores that lifestyle modification remains crucial.
The second discussant, Alexandra E. Hovaguimian, MD, is an Assistant Professor of Neurology at Harvard Medical School and a member of the Department of Neurology at Beth Israel Deaconess Medical Center. Dr. Hovaguimian stresses that rapid and effective acute treatment is essential to prevent progression to chronic migraine. She notes that triptans are more effective than gepants for rapid pain relief, but gepants uniquely avoid medication overuse headache (MOH) and can be used during the prodrome phase. For prevention, she supports early use of CGRP monoclonal antibodies or atogepant, citing their rapid onset and superior tolerability compared to older oral preventives. For Ms. D, she recommends continuing ubrogepant acutely and initiating monthly erenumab for prevention, with counseling on reproductive planning and cardiovascular considerations related to migraines with aura and the use of estrogen-based contraceptives.
Both experts agree that migraine management should be individualized and informed by headache frequency, functional impairment, comorbidities, reproductive goals, and patient preference. They also note the growing role of multidisciplinary education, including headache diaries, behavioral modification, and recognition of MOH, in improving outcomes.
All “Beyond the Guidelines” features are based on selected clinical conferences at Beth Israel Deaconess Medical Center (BIDMC) and include multimedia components published in the Annals of Internal Medicine.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact one of the discussants, please email Kendra McKinnon at kmckinn1@bidmc.harvard.edu.
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Also new this issue:
Inpatient Management of Patients With Cirrhosis
Shari Rogal, MD, MPH
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00527
Journal
Annals of Internal Medicine
Method of Research
News article
Subject of Research
People
Article Title
Short Versus Longer Antibiotic Duration for Community-Acquired Pneumonia: A Multicenter Target Trial Emulation
Article Publication Date
14-Apr-2026
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