Improving adherence with antimicrobial therapy for respiratory tract infections: a discussion of directly observed therapy (DOT) and short-course therapies.

Although some of the variables associated with adherence (eg, patient age, place of residence) cannot be influenced, others are very amenable to modifications. Levels of adherence correlate with the convenience of dosage regimens, as shown in a number of clinical trials. Therefore, antimicrobial agents that are well accepted by patients should be considered whenever feasible. Such agents include those that enable shortterm therapy with the fewest daily doses and shortest effective treatment regimens. DOT, a cost-effective and clinically effective approach for certain chronic conditions, may also have practical implications for the treatment of acute infectious diseases, such as CAP, AECB, and otitis media. Although there are a number of challenges to the implementation of DOT for these conditions, such an approach may be beneficial, particularly when short-course antibiotic therapy is indicated and appropriate candidates are identified for treatment.