Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-28T11:31:21.399Z Has data issue: false hasContentIssue false

Chapter 6 - Duration of Therapy

Our Role as Stewards

Published online by Cambridge University Press:  06 April 2018

Tamar F. Barlam
Affiliation:
Boston Medical Center
Melinda M. Neuhauser
Affiliation:
Department of Veteran Affairs
Pranita D. Tamma
Affiliation:
The Johns Hopkins University School of Medicine
Kavita K. Trivedi
Affiliation:
Trivedi Consults, LLC.
Get access

Summary

Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Martin, SJ, Micek, ST, Wood, GC. Antimicrobial resistance: consideration as an adverse drug event. Crit Care Med 2010; 38(Suppl 6):S155S1561.Google Scholar
File, TM Jr. Clinical efficacy of newer agents in short-duration therapy for community-acquired pneumonia. Clin Infect Dis 2004; 39 (Suppl 3):S159–164.Google Scholar
File, TM Jr. Duration and cessation of antimicrobial treatment. J Hosp Med 2012; 7 (Suppl 1):S22–33.Google Scholar
Hayashi, Y, Paterson, DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011; 52(10):12321240.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Delayed Prescribing Practices. 2015. (Accessed March 23, 2016, at www.cdc.gov/getsmart/community/improving-prescribing/interventions/delayed-prescribing-practices.html.)Google Scholar
Niederman, MS, Mandell, LA, Anzueto, A, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163(7):17301754.CrossRefGoogle ScholarPubMed
Leophonte, PC, Choutet, P, Gaillat, J, et al. Efficacy of a ten day course of ceftriaxone compared to a shortened five day course in the treatment of community-acquired pneumonia in hospitalized adults with risk factors. Medecine et Maladies Infectieuses 2002; 32(7):369381.Google Scholar
Dunbar, LM, Wunderink, RG, Habib, MP, et al. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis 2003; 37(6):752–60.Google Scholar
el Moussaoui, R, de Borgie, CA, van den Broek, P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ 2006; 332(7554):1355.Google Scholar
Rizzato, G, Montemurro, L, Fraioli, P, et al. Efficacy of a three day course of azithromycin in moderately severe community-acquired pneumonia. Eur Respir J 1995; 8(3):398402.CrossRefGoogle ScholarPubMed
Schonwald, S, Skerk, V, Petricevic, I, et al. Comparison of three-day and five-day courses of azithromycin in the treatment of atypical pneumonia. Eur J Clin Microbiol Infect Dis 1991; 10(10):877880.Google Scholar
Yanagihara, K, Izumikawa, K, Higa, F, et al. Efficacy of azithromycin in the treatment of community-acquired pneumonia, including patients with macrolide-resistant Streptococcus pneumoniae infection. Intern Med 2009; 48(7):527535.Google Scholar
Li, JZ, Winston, LG, Moore, DH, Bent, S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med 2007; 120(9):783790.Google Scholar
Dimopoulos, G, Matthaiou, DK, Karageorgopoulos, DE, et al. Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs 2008; 68(13):18411854.Google Scholar
Agarwal, G, Awasthi, S, Walter, SD, et al. Three day versus five day treatment with amoxicillin for non-severe pneumonia in young children: a multicentre randomised controlled trial. BMJ 2004; 328(7443):791.Google ScholarPubMed
Kartasasmita, C, Saha, S., Short Course Cotrimoxazole Study Group. Three days versus five days oral cotrimoxazole for non-severe pneumonia: Consultative meeting to review evidence and research priorities in the management of acute respiratory infections (ARI). Geneva: World Health Organization 2003.Google Scholar
Lupison, SP, Medalla, MF, Miguel, CA, Nisperos, E, Sunico, ES. A randomised, placebo controlled trial of short course cotrimoxazole for the treatment of pneumonia in Filipino children. Philippine Journal of Microbiology and Infectious Diseases 1999; 28(1):1520.Google Scholar
Pakistan Multicentre Amoxycillin Short Course Therapy (MASCOT) Pneumonia Study Group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet 2002; 360(9336):835841.Google Scholar
Mandell, LA, Wunderink, RG, Anzueto, A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2):S27–72.Google Scholar
Lim, WS, Baudouin, SV, George, RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009; 64(Suppl 3):iii55.CrossRefGoogle ScholarPubMed
American Thoracic Society and Society of American Infectious Diseases. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171(4):388416.Google Scholar
Dennesen, PJ, van der Ven, AJ, Kessels, AG, Ramsay, G, Bonten, MJ. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 2001; 163(6):13711375.Google Scholar
Luna, CM, Blanzaco, D, Niederman, MS, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003; 31(3):676682.Google Scholar
Ibrahim, EH, Ward, S, Sherman, G, et al. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001; 29(6):11091115.Google Scholar
Singh, N, Rogers, P, Atwood, CW, Wagener, MM, Yu VL, . Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000; 162(2 Pt 1):505511.Google Scholar
Micek, ST, Ward, S, Fraser, VJ, Kollef, MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004; 125(5):17911799.Google Scholar
Chastre, J, Wolff, M, Fagon, JY, et al. Comparison of 8 vs. 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003; 290(19):25882598.Google Scholar
Hedrick, TL, McElearney, ST, Smith, RL, et al. Duration of antibiotic therapy for ventilator-associated pneumonia caused by non-fermentative gram-negative bacilli. Surg Infect (Larchmt) 2007; 8(6):589597.Google Scholar
Dimopoulos, G, Poulakou, G, Pneumatikos, IA, et al. Short- vs. long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest 2013; 144(6):17591767.Google Scholar
Pugh, R, Grant, C, Cooke, RP, Dempsey, G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev 2015; 8:CD007577.Google Scholar
Kalil, AC, Metersky, ML, Klompas, M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63(5):e61e111.Google Scholar
Avdic, E, Cushinotto, LA, Hughes, AH, et al. Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia. Clin Infect Dis 2012; 54(11):15811587.Google Scholar
Li, DX, Ferrada, MA, Avdic, E, Tamma, PD, Cosgrove, SE. Sustained impact of an antibiotic stewardship intervention for community-acquired pneumonia. Infect Control Hosp Epidemiol 2016; 37(10):12431246.CrossRefGoogle ScholarPubMed
Haas, MK, Dalton, K, Knepper, BC, et al. Effects of a syndrome-specific antibiotic stewardship intervention for inpatient community-acquired pneumonia. Open Forum Infect Dis 2016; 3(4):ofw186.Google Scholar
Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40(5):643654.Google Scholar
Shapiro, DJ, Hicks, LA, Pavia, AT, Hersh, AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother 2014; 69(1):234240.CrossRefGoogle ScholarPubMed
Gossius, G and Vorland, L. A randomised comparison of single-dose vs. three-day and ten-day therapy with trimethoprim-sulfamethoxazole for acute cystitis in women. Scand J Infect Dis 1984; 16(4):373379.Google Scholar
Trienekens, TA, Stobberingh, EE, Winkens, RA, Houben, AW. Different lengths of treatment with co-trimoxazole for acute uncomplicated urinary tract infections in women. BMJ 1989; 299(6711):13191322.Google Scholar
Warren, JW, Abrutyn, E, Hebel, JR, et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999; 29(4):745758.Google Scholar
Counts, GW, Stamm, WE, McKevitt, M, et al. Treatment of cystitis in women with a single dose of trimethoprim-sulfamethoxazole. Rev Infect Dis 1982; 4(2):484490.Google Scholar
Tolkoff-Rubin, NE, Weber, D, Fang, LS, et al. Single-dose therapy with trimethoprim-sulfamethoxazole for urinary tract infection in women. Rev Infect Dis 1982; 4(2):444448.Google Scholar
Schultz, HJ, McCaffrey, LA, Keys, TF, Nobrega, FT. Acute cystitis: a prospective study of laboratory tests and duration of therapy. Mayo Clin Proc 1984; 59(6):391397.Google Scholar
Leibovici, L, Laor, A, Alpert, G, Kalter-Leibovici, O. Single-dose treatment of urinary tract infection in young women: data indicating a high rate of recurrent infection during a short follow-up. Isr J Med Sci 1984; 20(3):257259.Google Scholar
Prentice, RD, Wu, L, Gehlbach, SH, et al. Treatment of lower urinary tract infections with single-dose trimethoprim-sulfamethoxazole. J Fam Pract 1985; 20(6):551557.Google Scholar
Fihn, SD, Johnson, C, Roberts, PL, Running, K, Stamm, WE. Trimethoprim-sulfamethoxazole for acute dysuria in women: a single-dose or 10-day course: a double-blind, randomized trial. Ann Intern Med 1988; 108(3):350357.Google Scholar
Saginur, R and Nicolle, LE. Single-dose compared with 3-day norfloxacin treatment of uncomplicated urinary tract infection in women: Canadian Infectious Diseases Society Clinical Trials Study Group. Arch Intern Med 1992; 152(6):12331237.Google Scholar
Arav-Boger, R, Leibovici, L, Danon, YL. Urinary tract infections with low and high colony counts in young women. Spontaneous remission and single-dose vs. multiple-day treatment. Arch Intern Med 1994; 154(3):300304.Google Scholar
Iravani, A, Tice, AD, McCarty, J, et al. Short-course ciprofloxacin treatment of acute uncomplicated urinary tract infection in women: the minimum effective dose. The Urinary Tract Infection Study Group [corrected]. Arch Intern Med 1995; 155(5):485494.Google Scholar
Iravani, A. Multicenter study of single-dose and multiple-dose fleroxacin versus ciprofloxacin in the treatment of uncomplicated urinary tract infections. Am J Med 1993; 94(3A):89S–96S.Google Scholar
Hooton, TM, Johnson, C, Winter, C, et al. Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women. Antimicrob Agents Chemother 1991; 35(7):14791483.Google Scholar
Leelarasamee, A and Leelarasamee, I. Comparative efficacies of oral pefloxacin in uncomplicated cystitis. Single dose or 3-day therapy. Drugs 1995; 49(Suppl 2):365367.CrossRefGoogle ScholarPubMed
The Inter-Nordic Urinary Tract Infection Study Group. Double-blind comparison of 3-day versus 7-day treatment with norfloxacin in symptomatic urinary tract infections: the Inter-Nordic Urinary Tract Infection Study Group. Scand J Infect Dis 1988; 20(6):619624.Google Scholar
Neringer, R, Forsgren, A, Hansson, C, Ode, B. Lomefloxacin versus norfloxacin in the treatment of uncomplicated urinary tract infections: three-day versus seven-day treatment. The South Swedish Lolex Study Group. Scand J Infect Dis 1992; 24(6):773780.Google Scholar
Fang, LS, Tolkoff-Rubin, NE, Rubin, RH. Efficacy of single-dose and conventional amoxicillin therapy in urinary-tract infection localized by the antibody-coated bacteria technic. N Engl J Med 1978; 298(8):413416.Google Scholar
Raz, R, Rottensterich, E, Boger, S, Potasman, I. Comparison of single-dose administration and three-day course of amoxicillin with those of clavulanic acid for treatment of uncomplicated urinary tract infection in women. Antimicrob Agents Chemother 1991; 35(8):16881690.Google Scholar
Savard-Fenton, M, Fenton, BW, Reller, LB, Lauer, BA, Byyny, RL. Single-dose amoxicillin therapy with follow-up urine culture: effective initial management for acute uncomplicated urinary tract infections. Am J Med 1982; 73(6):808813.Google Scholar
Rubin, RH, Fang, LS, Jones, SR, et al. Single-dose amoxicillin therapy for urinary tract infection: multicenter trial using antibody-coated bacteria localization technique. JAMA 1980; 244(6):561564.Google Scholar
Greenberg, RN, Sanders, CV, Lewis, AC, Marier, RL. Single-dose cefaclor therapy of urinary tract infection: evaluation of antibody-coated bacteria test and C-reactive protein assay as predictors of cure. Am J Med 1981; 71(5):841845.Google Scholar
Iravani, A, Richard, GA. Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections. Antimicrob Agents Chemother 1989; 33(8):12121216.Google Scholar
Pitkajarvi, T, Pyykonen, ML, Kannisto, K, Piippo, T, Viita, P. Pivmecillinam treatment in acute cystitis: three versus seven days study. Arzneimittelforschung 1990; 40(10):11561158.Google Scholar
Gupta, K, Hooton, TM, Naber, KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52(5):e103–120.Google Scholar
Kavatha, D, Giamarellou, H, Alexiou, Z, et al. Cefpodoxime-proxetil versus trimethoprim-sulfamethoxazole for short-term therapy of uncomplicated acute cystitis in women. Antimicrob Agents Chemother 2003; 47(3):897900.Google Scholar
Gupta, K, Hooton, TM, Roberts, PL, Stamm, WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 2007; 167(20):22072212.Google Scholar
Christiaens, TC, De Meyere, M, Verschraegen, G, et al. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract 2002; 52(482):729734.Google Scholar
Iravani, A, Klimberg, I, Breifer, C, et al. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. J Antimicrob Chemother 1999; 43(Suppl A):6775.Google Scholar
Stein, GE. Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. Clin Ther 1999; 21(11):18641872.Google Scholar
Huttner, A, Verhaegh, EM, Harbarth, S, et al. Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials. J Antimicrob Chemother 2015; 70(9): 24562464.Google Scholar
Talan, DA, Stamm, WE, Hooton, TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA 2000; 283(12):15831590.Google Scholar
Klausner, HA, Brown, P, Peterson, J, et al. A trial of levofloxacin 750 mg once daily for 5 days versus ciprofloxacin 400 mg and/or 500 mg twice daily for 10 days in the treatment of acute pyelonephritis. Curr Med Res Opin 2007; 23(11):26372645.Google Scholar
Peterson, J, Kaul, S, Khashab, M, Fisher, AC, Kahn, JB. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology 2008; 71(1):1722.Google Scholar
Jernelius, H, Zbornik, J, Bauer, CA. One or three weeks’ treatment of acute pyelonephritis? A double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam. Acta Med Scand 1988; 223(5):469477.Google Scholar
de Gier, R, Karperien, A, Bouter, K, et al. A sequential study of intravenous and oral Fleroxacin for 7 or 14 days in the treatment of complicated urinary tract infections. Int J Antimicrob Agents 1995; 6(1):2730.Google Scholar
Kyriakidou, KG, Rafailidis, P, Matthaiou, DK, Athanasiou, S, Falagas, ME. Short- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: a meta-analysis of randomized controlled trials. Clin Ther 2008; 30(10):18591868.Google Scholar
Hecker, MT, Fox, CJ, Son, AH, et al. Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting. PLoS One 2014; 9(2):e87899.Google Scholar
Collins, CD, Kabara, JJ, Michienzi, SM, Malani, AN. Impact of an antimicrobial stewardship care bundle to improve the management of patients with suspected or confirmed urinary tract infection. Infect Control Hosp Epidemiol 2016; 37(12):14991501.Google Scholar
Mazuski, JE, Sawyer, RG, Nathens, AB, et al. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: evidence for the recommendations. Surg Infect (Larchmt) 2002; 3(3):175233.Google Scholar
Solomkin, JS, Mazuski, JE, Baron, EJ, et al. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis 2003 37(8):9971005.CrossRefGoogle ScholarPubMed
Sawyer, RG, Claridge, JA, Nathens, AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 2015; 372(21):19962005.Google Scholar
Lennard, ES, Dellinger, EP, Wertz, MJ, Minshew, BH. Implications of leukocytosis and fever at conclusion of antibiotic therapy for intra-abdominal sepsis. Ann Surg 1982; 195(1):1924.Google Scholar
Hedrick, TL, Evans, HL, Smith, RL, et al. Can we define the ideal duration of antibiotic therapy? Surg Infect (Larchmt) 2006; 7(5):419432.Google Scholar
Solomkin, JS, Mazuski, JE, Bradley, JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50(2):133164.Google Scholar
Popovski, Z, Mercuri, M, Main, C, et al. Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J Antimicrob Chemother 2015; 70(4):12261229.Google Scholar
Jenkins, TC, Sabel, AL, Sarcone, EE, et al. Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship. Clin Infect Dis 2010; 51(8):895903.Google Scholar
Hepburn, MJ, Dooley, DP, Skidmore, PJ, et al. Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis. Arch Intern Med 2004; 164(15):16691674.Google Scholar
Prokocimer, P, De Anda, C, Fang, E, Mehra, P, Das, A. Tedizolid phosphate vs. linezolid for treatment of acute bacterial skin and skin structure infections: the ESTABLISH-1 randomized trial. JAMA 2013; 309(6):559569.CrossRefGoogle ScholarPubMed
Duong, M, Markwell, S, Peter, J, Barenkamp, S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010; 55(5):401407.Google Scholar
Macfie, J, Harvey, J. The treatment of acute superficial abscesses: a prospective clinical trial. Br J Surg 1977; 64(4):264266.Google Scholar
Llera, JL and Levy, RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med 1985; 14(1):1519.Google Scholar
Rutherford, WH, Hart, D, Calderwood, JW, Merrett, JD. Antibiotics in surgical treatment of septic lesions. Lancet 1970; 1(7656):10771080.Google Scholar
Schmitz, GR, Bruner, D, Pitotti, R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med 2010; 56(3):283287.CrossRefGoogle ScholarPubMed
Stevens, DL, Bisno, AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59(2):147159.Google Scholar
Holmes, L, Ma, C, Qiao, H, et al. Trimethoprim-sulfamethoxazole therapy reduces failure and recurrence in methicillin-resistant Staphylococcus aureus skin abscesses after surgical drainage. J Pediatr 2016; 169:128134 e1.Google Scholar
Talan, DA, Mower, WR, Krishnadasan, A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016; 374(9):823832.CrossRefGoogle ScholarPubMed
Jenkins, TC, Knepper, BC, Sabel, AL, et al. Decreased antibiotic utilization after implementation of a guideline for inpatient cellulitis and cutaneous abscess. Arch Intern Med 2011; 171(12):10721079.Google Scholar
Rice, LB. The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and Clostridium difficile. Clin Infect Dis 2008; 46(4):491496.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×