301. Duration of Antibiotic Therapy for Bacteremia: A Systematic Review
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: The optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy are as effective as longer durations in treating many common infections, and similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, antibiotic resistance and costs. 

Methods: A search of multiple databases was conducted for the years 1947-2010, and supplemented by manual searches of reviews and reference lists. Controlled trials randomizing patients to different durations of treatment with the same antibiotic regimen for bloodstream infections, catheter-related bloodstream infections (CRBSI), intra-abdominal infections, pneumonia, pyelonephritis and skin and soft-tissue infections (SSTI) were included. Data were extracted on study design, patient population, antibiotic interventions, inclusion of bacteremic patients, and clinical outcomes.

Results: 24 trials utilizing a variety of antibiotic durations were identified for inclusion, which consisted of 1 trial in bacteremia, 0 in CRBSI, 3 in intra-abdominal infection, 6 in pyelonephritis, 13 in pneumonia and 1 in SSTI. 13 studies reported on 227 total patients with bacteremia who were allocated to ‘short’ or ‘long’ durations of treatment. Treatment outcomes for bacteremic patients were available for 155 patients receiving treatment for neonatal bacteremia (66 patients), intra-abdominal infection (40) pyelonephritis (9), and pneumonia (40). No significant differences were found in rates of clinical cure or survival in bacteremic patients, with successful treatment of 66/74 (89.2%) of bacteremic patients receiving short duration of therapy (range 5-7 days) and 75/81 (92.6%) receiving long duration of therapy (7-21 days). One trial detected a significant difference in cure for patients receiving 7 days (42.9% cured) versus 14 days (100% cured) of therapy for a subgroup with S. aureus bacteremia.

Conclusion: Little prospective evidence exists to guide duration of antibiotic treatment in bacteremia. The available data suggests clinical cure of bacteremic patients has been achieved with shortened durations of treatment (5 to 7 days), but a larger trial of bacteremic patients is needed to validate these observations.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Thomas Havey, MD, Robert Fowler, MD, MSc and Nick Daneman, MD, MSc, University of Toronto, Toronto, ON, Canada

Disclosures:

T. Havey, None

R. Fowler, None

N. Daneman, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.