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Duration of Antibiotic Therapy for Bacteremia: A Systematic Review and Meta-Analysis
Study Question: What is the optimal duration of antibiotic therapy for patients with non-Staphylococcus aureus bacteremia?
Study Description: A search through MEDLINE, EMBASE, and COCHRANE databases was conducted to identify trials which randomized patients to shorter (from 5-7 days) versus longer duration (from 7-21 days) of antibiotics for bacteremia or infections that commonly cause bacteremia, including catheter-related blood stream infections (CRBSIs); intra-abdominal infections; pneumonia; pyelonephritis; and skin and soft tissue infections (SSTIs). Eligible trials randomized patients to two durations of the same antibiotic regimen to evaluate clinical cure, microbiologic cure, or survival. Trials were excluded for duration of therapy based on physician discretion, clinical improvement, or biomarker measurements.
Results: Twenty-four trials were included in the meta-analysis yielding outcome data for a total of 155 patients with positive blood cultures. One trial focused on patients with bacteremia, and the other 23 evaluated other infections causing bacteremia (0 CRBSI, 3 intra-abdominal infections, 6 pyelonephritis, 1 SSTI, and 13 pneumonia). There were no significant differences overall for clinical cure (87% vs. 96%, risk ratio 0.88, 95% CI 0.77-1.01, p = 0.37), microbiologic cure (100% vs 94%, risk ratio 1.05, 95%, CI 0.91-1.21, p = 0.78), or survival (88% vs 89.6%, risk ratio 0.97, 95% CI 0.76-1.23, p = 0.36). No significant heterogeneity between studies was detected for clinical cure (I2=5%), microbiologic cure (I2=0%), or survival (I2=3%).
Conclusion(s): The authors cautiously concluded there are no significant differences in clinical cure, microbiologic cure, or survival for shorter versus longer antibiotic therapy in the treatment of bacteremia. This indicates shorter duration of therapy may be efficacious for treatment of bacteremia, though a larger randomized trial is needed to further support of these findings. The limited number of patients represented in the outcomes suggest future trials should be completed to consider a change in antibiotic duration in bacteremic patients.
Perspective: This article emphasizes the lack of evidence that exists for optimal duration of antibiotic treatment of various illnesses. The possibility of shorter antibiotic durations for bacteremia seems promising, but it is important to keep in mind that this meta-analysis only included one trial focused specifically on bacteremic patients.
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