Compliance in Anti-infective Medicine

Compliance, or adherence, is the extent to which the time history of drug administration corresponds to the prescribed regimen. Patients in hospital are generally compliant with treatment because they are provided with each dose at the relevant time. However, noncompliance is a frequent problem in the outpatient setting and can result in patients receiving inappropriate doses of medication. Patient noncompliance with acute antibiotic therapy develops consciously and subconsciously: the longer and more complex the regimen, the poorer the compliance. Noncompliance can affect clinical outcomes and increase treatment costs, thus comprehensive methods to improve compliance need to be introduced and widely used. The links between poor compliance and resistance have been clearly demonstrated in chronic infections, such as tuberculosis. There is less evidence from respiratory tract infections (RTIs), but there is evidence that inappropriate dosing can lead to resistance development. In children with RTIs, there is convincing evidence that highdose, short-course amoxicillin is effective, tolerable, offers improved compliance, and is associated with less short-term resistant carriage rates in the individual than standard therapy. High-dose, short-course macrolide therapy has not been studied as extensively, but in the appropriate setting it reduces noncompliance and has comparable effectiveness to longcourse β-lactam therapy. (Adv Stud Med. 2006;6(7C):S652-S658)