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

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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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Figure 1 Flowchart describing citations screened, studies included for searches of bacteremia, and infectious syndromes most commonly causing bacteremia. CRBSI, catheter-related bloodstream infection; SSTI, skin and soft tissue infection.CC BY · PubMed Central

Figure 2 Forest plot for outcome of clinical cure among bacteremic subgroups of randomized trials of shorter versus longer antibiotic treatment. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.CC BY · PubMed Central

Figure 3 Forest plot for outcome of microbiologic cure among bacteremic subgroups of randomized trials of shorter versus longer antibiotic treatment. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.CC BY · PubMed Central

Figure 4 Forest plot for outcome of survival among bacteremic subgroups of randomized trials of shorter versus longer antibiotic treatment. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel.CC BY · PubMed Central

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Additional file 1 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414728
Additional file 5 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414746
Additional file 7 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414758
Additional file 6 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414749
Additional file 2 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414731
Additional file 8 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414764
Additional file 4 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414737
Additional file 1 of The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults
Sieswerda, E., Bax, H. I., Hoogerwerf, J. J., de Boer, M. G. J., Boermeester, M. A., Bonten, M. J. M., Dekker, D., van Wijk, R. G., Juffermans, N. P., Kuindersma, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20479548
Additional file 3 of Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers
Borges, I. N., Carneiro, R. M., Bergo, R., Martins, L., Colosimo, E. A., Oliveira, C., Saturnino, S. F., de Andrade, M. V. M., Ravetti, C., & Junior, V. A. N. (2020) · Figshare · doi:10.6084/m9.figshare.12414734
Additional file 1 of Impact of a restrictive antibiotic policy on the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an endemic region: a before-and-after, propensity-matched cohort study in a Caribbean intensive care unit
Terrier, C. L., Vinetti, M., Bonjean, P., Richard, R., Jarrige, B., Pons, B., Madeux, B., Piednoir, P., Ardisson, F., Elie, E., et al. (2021) · Figshare · doi:10.6084/m9.figshare.15058132
Executive Summary of the 2020 Clinical Practice Guidelines for Sepsis and Septic Shock in Adults in the Philippines
Buensalido, J. A. L., Malundo, A. F. G., Aherrera, J. A. M., Magno, J. D. A., Maramara, M. K. P., Punzalan, F. E. R., Tolosa, M. T. S., Briones, G., Hernandez, A. M. R., Pantaleon, A. F., et al. (2022) · Philippine Journal of Internal Medicine · doi:10.65564/pjim.10a45be121
Optimizing prevention, diagnosis and treatment of intravascular catheter-related infections in critically ill patients
Buetti, N. (2021) · theses.fr (ABES) · doi:10.70675/afd95390z90e3z46a1za9bdzc9bfac164ea4
Seven versus fourteen days for resistant bloodstream infections: what do we actually know? A scoping review
Zuccaro, V., Asperges, E., Marvulli, L. N., Valsecchi, P., Pagani, E., Sacchi, P., & Bruno, R. (2026) · Infection · doi:10.1007/s15010-026-02821-y
Effect of adding metronidazole to meropenem on clinical efficacy in complicated intra-abdominal infections: a retrospective study
Nakashima, H., Miyazaki, M., Nishimura, N., Maeyama, R., Yoshikuni, K., & Imakyure, O. (2026) · BMC Infectious Diseases · doi:10.1186/s12879-026-13775-9
Optimising antibiotic ‘review and revise’ in acute/general medical inpatients: the Antibiotic Review Kit in Hospitals (ARK-Hospital) research programme including a stepped-wedge cluster-randomised trial
Llewelyn, M., Budgell, E. P., Pouwels, K. B., Morrell, L., Roope, L. S. J., Sivyer, K., Santillo, M., Mowbray, F., Cross, E. L. A., Laskawiec-Szkonter, M., et al. (2025) · Programme Grants for Applied Research · doi:10.3310/gjaw4014

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: Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
Health Sciences › Medicine › Pharmacology (medical) › Antibiotics Pharmacokinetics and Efficacy
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › 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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