Towards antibiotic stewardship: Reducing antibiotic duration

7 days non-inferior to 14 days of antibiotic therapy for uncomplicated Gram-negative bacteremia

In patients hospitalized with uncomplicated Gram-negative bacteremia, an antibiotic course of 7 days was non-inferior to 14 days, according to a randomized, multicenter trial published in Clinical Infectious Diseases, an official journal of the Infectious Diseases Society of America (IDSA).

The study conducted in three centers in Israel and Italy examined 604 hospitalized patients with uncomplicated i.e. afebrile and hemodynamically stable for at least 48 hours, gram-negative bacteremia (mostly Enterobacteriaceae). The patients were randomized to antibiotic treatment for 7 days and 14 days.

The primary outcome – composite of all-cause mortality; relapse, suppurative or distant complications and re-admission or extended hospitalization (>14 days) – rates were comparable in the two groups; 46 in the 7 days group vs 48.3% in the 14 days group suggesting that the 7-day course of antibiotic was non-inferior to the longer course.

Hence, patients who respond to the antibiotic may be given a 7-day treatment instead of 14 days.

(Reference: Yahav D, et al. Seven versus fourteen days of antibiotic therapy for uncomplicated gram-negative bacteremia: a non-inferiority randomized controlled trial. Clin Infect Dis. 2018 Dec 11. doi: 10.1093/cid/ciy1054. Epub ahead of print)

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