IntroductionBased on expert opinion the length of antibiotic treatment for pleural infection in adults is typically recommended to be a minimum of four weeks. This clinical trial aimed to assess whether shorter antibiotic courses lead to more treatment failures than standard longer courses.MethodsIn an open-label randomised controlled trial adult patients with pleural infection who were medically treated and stabilised within 14 days of admission were randomised to either a short antibiotic course (total course 14–21 days) or a long antibiotic course (total course 28–42 days). Patients were excluded if their baseline RAPID score was >4 (high-risk category). The primary outcome was the incidence of treatment failure by 6 weeks post admission. Secondary outcomes were total length of antibiotic treatment, proportion of patients who resumed normal activity levels within 6 weeks post admission, time from discharge to resuming normal activity levels and the incidence of antibiotic-related adverse reactions.ResultsBetween September 2020 and October 2021 50 patients (35 (70%) males, mean age 46±13.7 years), were recruited to the trial and randomly assigned to the short course group (n=25) or the long course group (n=25) with outcome data available for 24 patients in each study group. Treatment failure occurred in 4 (16.7%) patients in the short course group and 3 (12.5%) patients in the long course group. In the intention-to-treat analysis the odds ratio for treatment failure in the long course group was 0.714 (95% CI 0.142–3.600, p=0.683). The median duration of antibiotic treatment in the short course group was 20.5 [18–22.5] days compared to 34.5 [32–38] days in the long course group (p <0.001). There were no statistically significant differences in the other outcomes.ConclusionIn medically treated adult patients with pleural infection a long course of antimicrobial therapy did not lead to less treatment failures in comparison to a shorter course. These findings need to be confirmed in a larger multi-centre trial.

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