Trial of short-course antimicrobial therapy for intraabdominal infection.
Open accessAbstract
BACKGROUND: The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS: We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections. RESULTS: Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, -0.5 percentage point; 95% confidence interval [CI], -7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, -4.0 days; 95% CI, -4.7 to -3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes. CONCLUSIONS: In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.).
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In RCTs of intra-abdominal infection, shorter duration antimicrobial therapy showed no difference in outcomes compared with longer duration.
“Intra-abdominal | Montravers 2018 (305) | 8 days | 15 days | No difference”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as Sawyer 2015 (293)
The Results report similar outcomes with shorter and longer antimicrobial therapy for intraabdominal infection. However, this paper reports approximately 4 versus 8 days, not the citing row’s 8 versus 15 days, and it does not identify itself as the Montravers 2018 trial. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn many RCTs of shorter versus longer antimicrobial courses for specific conditions, the shorter course was as effective as the longer course but associated with fewer adverse consequences.
“In many of the trials, the shorter course was just as effective as the longer course but associated with fewer adverse consequences.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [293]
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Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694 · see citing works
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Intensive Care Medicine · doi:10.1007/s00134-012-2769-8 · Cited by 7,282 · see citing works
Intravenous Fluids and Acute Kidney Injury
Ding, X., Cheng, Z., & Qian, Q. (2017) · Blood Purification · doi:10.1159/000452702 · Cited by 6,866 · see citing works
Solomkin, J. S., Mazuski, J. E., Bradley, J. S., Rodvold, K. A., Goldstein, E. J. C., Baron, E. J., O’Neill, P. J., Chow, A. W., Dellinger, E. P., Eachempati, S. R., et al. (2009) · Clinical Infectious Diseases · doi:10.1086/649554 · Cited by 1,571 · see citing works
Self-citationChastre, J., Wolff, M., Fagon, J.-Y., Chevret, S., Thomas, F., Wermert, D., Clementi, E., Gonzalez, J., Jusserand, D., Asfar, P., et al. (2003) · JAMA · doi:10.1001/jama.290.19.2588 · Cited by 1,376 · see citing works
National Hospital Discharge Survey, 1988
United States Department of Health and Human Services. National Center for Health Statistics (1991) · ICPSR Data Holdings · doi:10.3886/icpsr09521.v1 · Cited by 1,310 · see citing works
Solomkin, J. S., Mazuski, J. E., Bradley, J. S., Rodvold, K. A., Goldstein, E. J. C., Baron, E. J., O’Neill, P. J., Chow, A. W., Dellinger, E. P., Eachempati, S. R., et al. (2010) · Surgical Infections · doi:10.1089/sur.2009.9930 · Cited by 620 · see citing works
Self-citationNational Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.
Kozak, L. J., Lees, K. A., & DeFrances, C. J. (2006) · PubMed · Cited by 422 · see citing works
Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study
Sartelli, M., Catena, F., Ansaloni, L., Coccolini, F., Corbella, D., Moore, E. E., Malangoni, M. A., Velmahos, G. C., Coimbra, R. S. M., Koike, K., et al. (2014) · World Journal of Emergency Surgery · doi:10.1186/1749-7922-9-37 · Cited by 311 · see citing works
Self-citationSource control in the management of severe sepsis and septic shock: An evidence-based review
Marshall, J. C., Maier, R. V., Jimenez, M. F., & Dellinger, E. P. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000143119.41916.5d · Cited by 290 · see citing works
Self-citationNational Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data.
DeFrances, C. J., Cullen, K. A., & Kozak, L. J. (2007) · PubMed · Cited by 256 · see citing works
Surgical Infection Society Intra-abdominal Infection Study
Christou, N. V. (1993) · Archives of Surgery · doi:10.1001/archsurg.1993.01420140070011 · Cited by 230 · see citing works
Mario Calvo, A. (2004) · Revista chilena de infectología · doi:10.4067/s0716-10182004000400012 · Cited by 119 · see citing works
Minimal antibiotic therapy after emergency abdominal surgery: A prospective study
Schein, M., Assalia, A., & Bachus, H. (1994) · British journal of surgery · doi:10.1002/bjs.1800810720 · Cited by 110 · see citing works
Turnbull, I. R., Javadi, P., Buchman, T. G., Hotchkiss, R. S., Karl, I. E., & Coopersmith, C. M. (2004) · Shock · doi:10.1097/01.shk.0000108399.56565.e7 · Cited by 97 · see citing works
Sursal, T., Stearns-Kurosawa, D. J., Itagaki, K., Oh, S., Sun, S., Kurosawa, S., & Hauser, C. J. (2012) · Shock · doi:10.1097/shk.0b013e318276f4ca · Cited by 91 · see citing works
Dupont, H., Friggeri, A., Touzeau, J., Airapetian, N., Tinturier, F., Lobjoie, E., Lorne, E., Hijazi, M., Regimbeau, J., & Mahjoub, Y. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr308 · Cited by 91 · see citing works
Basoli, A., Chirletti, P., Cirino, E., D'Ovidio, N., Doglietto, G. B., Giglio, D., Giulini, S. M., Malizia, A., Taffurelli, M., Petrovic, J., et al. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0277-x · Cited by 78 · see citing works
Riccio, L. M., Popovsky, K. A., Hranjec, T., Politano, A. D., Rosenberger, L. H., Tura, K. C., & Sawyer, R. G. (2014) · Surgical Infections · doi:10.1089/sur.2012.077 · Cited by 63 · see citing works
Self-citationInui, T., Haridas, M., Claridge, J. A., et al. (2009) · Surgery · doi:10.1016/j.surg.2009.06.051 · Cited by 57 · see citing works
Self-citationGuirao, X., García, M. S., Bassetti, M., et al. (2013) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkt143 · Cited by 27 · see citing works
Wong, Y.-Y., Wong, P.-N., Mak, S., et al. (2013) · Peritoneal Dialysis International · doi:10.3747/pdi.2012.00281 · Cited by 21 · see citing works
Samuelsson, A., Isaksson, B., Jonasson, J., Nilsson, L. E., Eriksson, O., Hanberger, H., & Chabok, A. (2012) · Scandinavian Journal of Infectious Diseases · doi:10.3109/00365548.2012.695455 · Cited by 13 · see citing works
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Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621 · see citing works
Self-citationSurviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652 · see citing works
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Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis
Gomi, H., Solomkin, J. S., Schlossberg, D., Okamoto, K., Takada, T., Strasberg, S. M., Ukai, T., Endo, I., Iwashita, Y., Hibi, T., et al. (2018) · Journal of Hepato-Biliary-Pancreatic Sciences · doi:10.1002/jhbp.518 · Cited by 451 · see citing works
Yahav, D., Franceschini, E., Koppel, F., Turjeman, A., Babich, T., Bitterman, R., Neuberger, A., Ghanem-Zoubi, N., Santoro, A., Eliakim-Raz, N., et al. (2019) · Clinical Infectious Diseases · doi:10.1093/cid/ciy1054 · Cited by 433 · see citing works
The new antibiotic mantra-“shorter is better”.
Spellberg, B. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.3646 · Cited by 291 · see citing works
Bloos, F., Trips, E., Nierhaus, A., Briegel, J., Heyland, D. K., Jaschinski, U., Moerer, O., Weyland, A., Marx, G., Gründling, M., et al. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2514 · Cited by 268 · see citing works
WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections
Sartelli, M., Coccolini, F., Kluger, Y., Agastra, E., Abu-Zidan, F. M., Abbas, A. E. S., Ansaloni, L., Adesunkanmi, A. K., Atanasov, B., Augustin, G., et al. (2021) · World Journal of Emergency Surgery · doi:10.1186/s13017-021-00387-8 · Cited by 207 · see citing works
Self-citationTabah, A., Bassetti, M., Kollef, M. H., Zahar, J.-R., Paiva, J.-A., Timsit, J.-F., Roberts, J. A., Schouten, J., Giamarellou, H., Rello, J., et al. (2020) · Intensive Care Medicine · doi:10.1007/s00134-019-05866-w · Cited by 191 · see citing works
For the DURAPOP Trial Group, Montravers, P., Tubach, F., Lescot, T., Veber, B., Esposito-Farèse, M., Seguin, P., Paugam, C., Lepape, A., Meistelman, C., et al. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5088-x · Cited by 173 · see citing works
Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections
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Hanretty, A. M., & Gallagher, J. C. (2018) · Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.2118 · Cited by 123 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
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Antimicrobial stewardship: a call to action for surgeons
Sartelli, M., Duane, T. M., Catena, F., Tessier, J. M., Coccolini, F., Kao, L. S., De Simone, B., Labricciosa, F. M., May, A. K., Ansaloni, L., et al. (2016) · Surgical Infections · doi:10.1089/sur.2016.187 · Cited by 107 · see citing works
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Coccolini, F., Sartelli, M., Sawyer, R., Rasa, K., Viaggi, B., Abu-Zidan, F., Soreide, K., Hardcastle, T., Gupta, D., Bendinelli, C., et al. (2023) · World Journal of Emergency Surgery · doi:10.1186/s13017-023-00509-4 · Cited by 99 · see citing works
Self-citationRoyer, S., DeMerle, K. M., Dickson, R. P., & Prescott, H. C. (2018) · Journal of Hospital Medicine · doi:10.12788/jhm.2905 · Cited by 94 · see citing works
Thorndike, J., & Kollef, M. H. (2020) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000751 · Cited by 42 · see citing works
Optimal antibiotic use in the intensive care unit
Micek, S. T., Vazquez Guillamet, M. C., Reynolds, D., Matuszak, S., Kolodziej, L., & Kollef, M. H. (2025) · Critical Care · doi:10.1186/s13054-025-05653-8 · Cited by 11 · see citing works
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Wiersinga, W. J. (2017) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000390 · Cited by 4 · see citing works
Risk of subsequent sepsis within 90 days after a hospital stay by type of antibiotic exposure.
Baggs, J., Jernigan, J. A., Halpin, A. L., Epstein, L., Hatfield, K. M., & McDonald, L. C. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/cix947 · Cited by 190 · see citing works
- Authors
- Sawyer, R. G., Claridge, J. A., Nathens, A. B., Rotstein, O. D., Duane, T. M., Evans, H. L., Cook, C. H., O’Neill, P. J., Mazuski, J. E., Askari, R., Wilson, M. A., Napolitano, L. M., Namias, N., Miller, P. R., Dellinger, E. P., Watson, C. M., Coimbra, R., Dent, D. L., Lowry, S. F., Cocanour, C. S., West, M. A., Banton, K. L., Cheadle, W. G., Lipsett, P. A., Guidry, C. A., & Popovsky, K.
- Affiliations
- Virginia Commonwealth University (US)
- From the Department of Surgery, University of Virginia Health System, Charlottesville (R.G.S., C.A.G., K.P.); the Department of Surgery, Virginia Commonwealth University, Richmond (T.M.D.); the Department of Surgery, Case Western Reserve University, Cleveland (J.A.C.); the Department of Surgery, University of Toronto, Toronto (A.B.N., O.D.R.); the Department of Surgery, University of Washington, Seattle (H.L.E., E.P.D.); the Department of Surgery, Beth Israel Deaconess Medical Center (C.H.C.), and the...
- Beth Israel Deaconess Medical Center (US)
- Brigham and Women's Hospital (US)
- University of Miami (US)
- University of South Carolina (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of Minnesota (US)
- University of Louisville (US)
- Johns Hopkins University (US)
- ORCID
- Sawyer, Robert G.
- Claridge, Jeffrey A.
- Nathens, Avery B.
- Rotstein, Ori D.
- Evans, Heather L.
- Cook, Charles H.
- Askari, Reza
- Napolitano, Lena M.
- Namias, Nicholas
- Miller, Preston R.
- Dellinger, E. Patchen
- Watson, Christopher M.
- Coimbra, Raul
- Dent, Daniel L.
- Cocanour, Christine S.
- Banton, Kaysie L.
- Lipsett, Pamela A.
- Guidry, Christopher A.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-05-21
- Volume
- 372
- Issue
- 21
- Pages
- 1996-2005
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4469182
- OpenAlex
- W2148077193
- Cited by
- 747
- References
- 23
- Citations by year
- 2026: 55 · 2025: 73 · 2024: 57 · 2023: 63 · 2022: 82 · 2021: 70 · 2020: 81 · 2019: 60 · 2018: 58 · 2017: 68 · 2016: 57 · 2015: 19
- FWCI
- 53.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (5t32ai078875-05)
- National Institute of General Medical Sciences (R01GM081510)
- National Institute of Allergy and Infectious Diseases (T32-AI078875)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- intra-abdominal infection, short-course antibiotic therapy, antibiotic duration, source control, surgical site infection, postoperative mortality, antibiotic stewardship
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Appendicitis, Drug Administration Schedule, Female, Fever, Humans, Leukocytosis, Male, Middle Aged, Peritonitis, Recurrence, Surgical Wound Infection, Sepsis, Kaplan-Meier Estimate, Medication Adherence, Young Adult, Intraabdominal Infections
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