Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

Abstract

IntroductionThe optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy have been demonstrated to be as effective as longer durations for many common infections; similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, resistance and costs.MethodsA search of the MEDLINE, EMBASE and COCHRANE databases was conducted for the years 1947-2010. Controlled trials were identified that randomized patients to shorter versus longer durations of treatment for bacteremia, or the infectious foci most commonly causing bacteremia in critically ill patients (catheter-related bloodstream infections (CRBSI), intra-abdominal infections, pneumonia, pyelonephritis and skin and soft-tissue infections (SSTI)).ResultsTwenty-four eligible trials were identified, including one trial focusing exclusively on bacteremia, zero in catheter related bloodstream infection, three in intra-abdominal infection, six in pyelonephritis, thirteen in pneumonia and one in skin and soft tissue infection. Thirteen studies reported on 227 patients with bacteremia allocated to 'shorter' or 'longer' durations of treatment. Outcome data were available for 155 bacteremic patients: neonatal bacteremia (n = 66); intra-abdominal infection (40); pyelonephritis (9); and pneumonia (40). Among bacteremic patients receiving shorter (5-7 days) versus longer (7-21 days) antibiotic therapy, no significant difference was detected with respect to rates of clinical cure (45/52 versus 47/49, risk ratio 0.88, 95% confidence interval [CI] 0.77-1.01), microbiologic cure (28/28 versus 30/32, risk ratio 1.05, 95% CI 0.91-1.21), and survival (15/17 versus 26/29, risk ratio 0.97, 95% CI 0.76-1.23).ConclusionsNo significant differences in clinical cure, microbiologic cure and survival were detected among bacteremic patients receiving shorter versus longer duration antibiotic therapy. An adequately powered randomized trial of bacteremic patients is needed to confirm these findings.

Bacterial sepsis

“…Similar results on de-escalation strategies were delivered by the studies of Turza and Havey et al [147,148]. Neither clinical and microbiologic recovery, nor survival were negatively influenced by a shorter treatment duration compared to groups with longer therapy.…”

Antibiotic Usage in Intensive Care Units of Tabriz Imam Reza Hospital, 2011

“…There was no similar study in this regard, but in a study, which had evaluated the effect of antibiotic therapy on final clinical results in patients with bacteremia, the results showed that the lengthening the time of antibiotic therapy makes no significant difference on clinical results (Havey et al, 2011).…”

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities

“…We selected a cut-off of more than 7 days of treatment based on evidence that most bacterial infections can be treated with a duration of 7 days or less of antibiotics. 6,[34][35][36][37][38] We considered consecutive prescriptions for the same antibiotic to be part of the same treatment course if the drug was prescribed by the same physician, to the same patient and there was no more than 3 days between prescriptions.…”