October 25, 2017
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Short courses of antibiotics show similar outcomes as prolonged therapy

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A short-term antibiotic course to treat Enterobacteriaceae bloodstream infection carried no greater risk for mortality than a long-term course and may in fact protect against multidrug-resistant gram-negative bacteria, researchers said.

“Our findings indicate that patients receiving 6 to 10 days of antibiotic therapy for uncomplicated Enterobacteriaceae bacteremia have a similar [chance] for survival in the ensuing 30 days as patients receiving longer courses of antibiotic therapy,” Darunee Chotiprasitsakul, MD, of the division of infectious diseases at Ramathibodi Hospital in Bangkok, and colleagues wrote in Clinical Infectious Diseases.

In their retrospective cohort study, the researchers included adult patients with Enterobacteriaceae bacteremia who were treated at Johns Hopkins Hospital, the University of Maryland Medical Center and the Hospital of the University of Pennsylvania between 2008 and 2014.

The outcomes of patients who had received either the short course of 6 to 10 days of antibiotic treatment or the long course of 11 to 16 days were assessed among 385 matched pairs. The median time of treatment in the short-course group was 8 days, compared with 15 days in the long-course group. About 30% of bloodstream infections were diagnosed in ICU patients.

The researchers noted that current Infectious Diseases Society of America guidelines for catheter-related gram-negative bloodstream infections suggest prescribing antibiotic therapy for 7 to 14 days, although this recommendation is considered “low-grade evidence because of limitations with existing studies addressing this question.”

Chotiprasitsakul and colleagues found no difference between the groups in all-cause mortality within 30 days of the end of treatment (adjusted HR = 1). In particular, 37 (9.6%) of the patients taking short-course therapy and 39 (10.1%) of the patients taking long-course therapy died within that period.

Similarly, there was little difference in the risk for recurrent bloodstream infections between the groups, the researchers said. However, they added that there were 17 (4.4%) reported occurrences of multidrug-resistant gram-negative bacteria resistance among the patients taking short-course therapy and 28 (7.3%) among the patients taking long-course therapy (OR = 0.59, P = .09).

“Shorter durations of therapy for uncomplicated Enterobacteriaceae bacteremia may protect patients from subsequent antibiotic drug-resistant organisms,” the researchers wrote. – by Joe Green

Disclosures: The authors report no relevant financial disclosures.