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The Short versus Long Antibiotic Course for Pleural Infection Management (SLIM) randomised controlled open-label
Maged Hassan1, Mohamed Gad-Allah1, Basma El-Shaarawy1
1Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt.
Introduction:
Based on expert opinion, the length of antibiotic treatment for pleural infection in adults is typically recommended to be a minimum of 4 weeks. This clinical trial aimed to assess whether shorter antibiotic courses lead to more treatment failures than standard longer courses.
Methods:
In an open-label randomised controlled trial, adult patients with pleural infection who were medically treated and stabilised within 14 days of admission were randomised to either a short antibiotic course (total course 14-21 days) or a long antibiotic course (total course 28-42 days). Patients were excluded if their baseline RAPID score was >4 (high-risk category). The primary outcome was the incidence of treatment failure by 6 weeks post-admission. Secondary outcomes were total length of antibiotic treatment, proportion of patients who resumed normal activity levels within 6 weeks post-admission, time from discharge to resuming normal activity levels and incidence of antibiotic-related adverse reactions.
Results:
Between September 2020 and October 2021, 50 patients (mean±sd age 46±13.7 years; 35 (70%) males) were recruited to the trial and randomly assigned to the short course group (n=25) or the long course group (n=25), with outcome data available for 24 patients in each study group. Treatment failure occurred in four (16.7%) patients in the short course group and three (12.5%) patients in the long course group. In the intention-to-treat analysis the OR for treatment failure in the long course group was 0.714 (95% CI 0.142-3.600; p=0.683). The median (interquartile range) duration of antibiotic treatment in the short course group was 20.5 (18-22.5) days compared with 34.5 (32-38) days in the long course group (p<0.001). There were no statistically significant differences in the other outcomes.
Conclusions:
In medically treated adult patients with pleural infection a long course of antimicrobial therapy did not lead to fewer treatment failures compared with a shorter course. These findings need to be confirmed in a larger multicentre trial.
Insights
Shorter antibiotic courses for pleural infection in adults did not increase treatment failures compared to longer courses. This suggests current treatment durations may be longer than necessary, warranting further investigation.
Area of Science:
- Infectious Diseases
- Clinical Trials
- Pulmonology
Background:
- The standard antibiotic treatment for adult pleural infection is typically a minimum of 4 weeks.
- There is a need to evaluate if shorter antibiotic regimens are as effective as longer ones.
Purpose of the Study:
- To compare the incidence of treatment failure between shorter (14–21 days) and longer (28–42 days) antibiotic courses for medically treated adult pleural infection.
- To assess secondary outcomes including antibiotic duration, recovery time, and adverse reactions.
Main Methods:
- An open-label randomized controlled trial was conducted with adult patients diagnosed with pleural infection.
- Patients were randomized into a short or long antibiotic course group, excluding those with a high baseline RAPID score (>4).
- The primary outcome was treatment failure at 6 weeks post-admission.
Main Results:
- Treatment failure occurred in 16.7% of the short course group and 12.5% of the long course group (OR 0.714; p=0.683).
- The median antibiotic treatment duration was significantly shorter in the short course group (20.5 days) compared to the long course group (34.5 days) (p<0.001).
- No significant differences were observed in other secondary outcomes.
Conclusions:
- A longer course of antibiotic therapy did not result in fewer treatment failures compared to a shorter course in medically treated adult patients with pleural infection.
- These findings suggest that shorter antibiotic durations may be viable, but require confirmation in larger multicenter trials.
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