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Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis
Open accessAbstract
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 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]
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The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection
Mazuski, J. E., Tessier, J. M., May, A. K., Sawyer, R. G., Nadler, E. P., Rosengart, M. R., Chang, P. K., O’Neill, P. J., Mollen, K. P., Huston, J. M., et al. (2017) · Surgical Infections · doi:10.1089/sur.2016.261 · Cited by 604
Metadata
- Authors
- Havey, T. C., Fowler, R. A., & Daneman, N.
- Affiliations
- University of Toronto (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Daneman, Nick
- Venue
- Critical Care
- Published
- 2011-11-15
- Volume
- 15
- Issue
- 6
- Pages
- R267-R267
- ISSN
- 1364-8535 (ISSN-L)
- 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
- 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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