Comparative Efficacy of 7-Day versus 14-Day Antibiotic Regimens for Bloodstream Infections
|
Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on April 16th, 2025
|
Bloodstream infections can be treated with antibiotics, but there is little consensus on the optimal treatment duration. A short-term, 7-day regimen may not be sufficient to eradicate the bacteria and might lead to the selection of resistant strains, while a longer, 14-day regimen could be excessive—resulting in adverse events, secondary infections, increased resistance pressure on non-pathogens, and unnecessary resource use. To answer this question, the Canadian Institutes of Health Research sponsored a study to determine the optimal treatment duration.
The study enrolled 3,608 patients hospitalized with bacterial bloodstream infections. Escherichia coli was the predominant pathogen, accounting for 43.8% of cases, followed by Klebsiella at 15.3% and Enterococcus at 6.9%. Over three-quarters of these infections were community-acquired, while the remainder were nosocomial. Participants were randomly assigned to receive either a 7-day or a 14-day course of antibiotics, with the choice of antibiotic left to the treating physician based on local guidelines and susceptibility profiles.
Using all-cause mortality within 90 days as the primary outcome, the researchers observed no significant difference between patients treated with a 7-day antibiotic regimen and those receiving a 14-day course. Likewise, there were no differences in hospital stay duration, the number of days on mechanical ventilation, or rates of bacteremia relapse. Additionally, the incidence of adverse events and the risk of secondary infections with antibiotic-resistant pathogens were similar between the two groups. The researchers also noted that their findings align with those from other comparative studies in pneumonia, pyelonephritis, cellulitis, and intraabdominal infections.
The study enrolled 3,608 patients hospitalized with bacterial bloodstream infections. Escherichia coli was the predominant pathogen, accounting for 43.8% of cases, followed by Klebsiella at 15.3% and Enterococcus at 6.9%. Over three-quarters of these infections were community-acquired, while the remainder were nosocomial. Participants were randomly assigned to receive either a 7-day or a 14-day course of antibiotics, with the choice of antibiotic left to the treating physician based on local guidelines and susceptibility profiles.
Using all-cause mortality within 90 days as the primary outcome, the researchers observed no significant difference between patients treated with a 7-day antibiotic regimen and those receiving a 14-day course. Likewise, there were no differences in hospital stay duration, the number of days on mechanical ventilation, or rates of bacteremia relapse. Additionally, the incidence of adverse events and the risk of secondary infections with antibiotic-resistant pathogens were similar between the two groups. The researchers also noted that their findings align with those from other comparative studies in pneumonia, pyelonephritis, cellulitis, and intraabdominal infections.