Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Pharmacology

Background:

• Bloodstream infections (BSI) pose significant risks for patient morbidity and mortality.
• Optimal antibiotic treatment duration for BSIs remains an area of clinical uncertainty.

Purpose of the Study:

• To determine if a 7-day antibiotic treatment course is noninferior to a 14-day course for hospitalized patients with bloodstream infections.

Main Methods:

• A multicenter, noninferiority randomized trial involving 3608 hospitalized patients with bloodstream infections.
• Patients were assigned to receive either 7 or 14 days of antibiotic therapy, with antibiotic choice determined by treating physicians.
• Exclusion criteria included severe immunosuppression, specific infection foci, contaminant-suspected cultures, and *Staphylococcus aureus* infections.

Main Results:

• The 90-day all-cause mortality rate was 14.5% in the 7-day group and 16.1% in the 14-day group, demonstrating noninferiority of the shorter duration (difference: -1.6 percentage points; 95.7% CI, -4.0 to 0.8).
• A per-protocol analysis also supported the noninferiority of the 7-day treatment duration.
• Findings were consistent across secondary outcomes and predefined subgroups.

Conclusions:

• Seven-day antibiotic treatment is noninferior to 14-day treatment for hospitalized patients diagnosed with bloodstream infections.
• This shorter duration offers a safe and effective alternative for managing common bloodstream infections.