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

Havey, Thomas C; Fowler, Robert A; Daneman, Nick

doi:10.1186/cc10545

Cited by 187Antibiotic Use and ResistanceAntibiotics Pharmacokinetics and EfficacySepsis Diagnosis and Treatment

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

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Havey, Thomas C, Fowler, Robert A, Daneman, Nick·2011·Critical Care

DOI 10.1186/cc10545PMC PMC3388653

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Abstract

Introduction: The 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. Methods: A 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)). Results: Twenty-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). Conclusions: No 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.

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Two meta-analyses reported reduced short-term mortality (RR, 0.70; 95% CI, 0.57-0.87) with prolonged infusion of beta-lactams.
“Two meta-analyses reported similar results supporting reduced short-term mortality (RR, 0.70; 95% CI, 0.57-0.87)with prolonged infusion of beta-lactams (232,233).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [233]
The Results section, “Outcomes among patients with bacteremia” (page unavailable), compares shorter with longer antibiotic courses and reports no significant difference in survival. A search for prolonged or continuous beta-lactam infusion and the stated mortality estimate found no passage addressing infusion strategy, so this copy cannot verify the attributed claim. (LLM, conf=0.76)
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Post-Cholecystectomy Mirizzi Syndrome: A Case Report and Review of the Literature
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RESEARCH Open Access Duration of antibiotic therapy for bacteremia: a
Daneman, N. (2014)
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Shortening Antibiotic Treatment Durations for Bacteremia
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218. Evaluation of Clinical Outcomes with Shorter Vs. Longer Duration of Treatment for Common Inpatient Bacterial Infections Associated with Bacteremia
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Effectiveness of Shorter Versus Longer Durations of Therapy for Common Inpatient Infections Associated With Bacteremia: A Multicenter, Propensity-Weighted Cohort Study
Hojat, L. S., Bessesen, M. T., Huang, M., Reid, M., Knepper, B. C., Miller, M. A., Shihadeh, K. C., Fugit, R. V., & Jenkins, T. C. (2019) · Clinical Infectious Diseases · doi:10.1093/cid/ciz1197 · Cited by 13 · see citing works

Authors: Havey, T. C., Fowler, R. A., & Daneman, N.
Affiliations: University of Toronto (CA)
Sunnybrook Health Science Centre (CA)
Corresponding author: Daneman, Nick
ORCID: Fowler, Robert A
Daneman, Nick
Venue: Critical Care
Publisher: Springer Science and Business Media LLC
Published: 2011-11-15
Volume: 15
Issue: 6
Pages: R267-R267
ISSN: 1364-8535 (ISSN-L)
DOI: 10.1186/cc10545
PMC: PMC3388653
OpenAlex: W2146470820
Cited by: 187
References: 60
Citations by year: 2026: 3 · 2025: 11 · 2024: 6 · 2023: 16 · 2022: 12 · 2021: 21 · 2020: 19 · 2019: 14 · 2018: 19 · 2017: 19 · 2016: 11 · 2015: 20 · 2014: 7 · 2013: 5 · 2012: 4
FWCI: 0.59
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0/ (tdm)
creativecommons.org/licenses/by/2.0/ (vor)
Locations: Critical Care (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
TSpace (University of Toronto) (submittedVersion)
Funders: Heart and Stroke Foundation of Canada
Ontario Ministry of Health and Long-Term Care
Canadian Institutes of Health Research
Topics: Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords: bacteremia, antibiotic duration, short-course antibiotic therapy, bloodstream infection, clinical cure, microbiologic cure, survival, catheter-related bloodstream infection, intra-abdominal infection, pyelonephritis, pneumonia, skin and soft tissue infections, neonatal bacteremia, antibiotic use
MeSH terms: Anti-Bacterial Agents, Humans, Pyelonephritis, Time Factors, Bacteremia, Pneumonia, Bacterial, Soft Tissue Infections, Catheter-Related Infections, Intraabdominal Infections

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

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