Shorter antibiotic course preferable for gram-negative bacteraemia

  • Yahav D & al.
  • Clin Infect Dis
  • 13 Sep 2019

  • International Clinical Digest
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Takeaway

  • 7 days of antibiotic therapy is noninferior to a 14-day course in haemodynamically stable patients hospitalised for gram-negative bacteraemia.

Why this matters

  • A shorter course limits antibiotic exposure and allows earlier return to baseline functional capacity.

Key results

  • 604 patients (306 short-, 298 long-duration arms).
  • Primary bacteraemia source: urinary tract (68%), main pathogen: Enterobacteriaceae (89.9%).
  • Primary 90-day endpoint was met by 45.8% (140/306) and 48.3% (144/298) of patients receiving 7- and 14-day antibiotics, respectively.
    • Primary endpoint defined as mortality, clinical failure, readmission, or extended hospitalisation: risk difference (RD), −2.6% (95% CI, −10.5% to 5.3%).
  • Stratified analysis: RD, −2.7% (95% CI, −10.7% to 5.2%).
  • Per-protocol analysis: endpoint met by 45.7% (128/280) and 47.8% (132/276) of patients receiving 7- and 14-day antibiotics, respectively (RD, −2.1%; 95% CI, −10.4% to 6.2%).
  • No mortality differences observed at 14 or 28 days; no difference in complications.
  • Time to return to baseline activity ≤90 days was significantly shorter with 7-day course (median, 2 [interquartile range (IQR), 0-8.3] weeks vs 3 [IQR, 1-12] weeks).

Study design

  • Randomised, open-label, noninferiority study analysing 7- vs 14-day antibiotic courses in hospitalised Italian, Israeli patients with gram-negative bacteraemia.
  • Funding: None disclosed.

Limitations

  • Findings limited to gram-negative nonfermenters.
  • Inability to demonstrate influence on resistance.
  • Potential to shorten hospital length of stay not demonstrated.