Antibiotic duration for common bacterial infections-a systematic review

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Clinical Trials

Background:

• Reducing antibiotic duration is a critical intervention to combat antimicrobial resistance (AMR).
• Current evidence on optimal antibiotic duration for common bacterial infections needs evaluation for gaps in settings, patient populations, and conditions.
• Trial methodologies require assessment for potential improvements.

Purpose of the Study:

• To examine existing evidence on antibiotic duration for common bacterial infections.
• To identify gaps in research regarding settings, patient populations, and specific infectious conditions.
• To assess trial methodologies and their impact on evidence quality.

Main Methods:

• A systematic literature search of MEDLINE and Embase was conducted up to July 2024 for randomized trials.
• Included trials compared different antibiotic durations in hospital and community settings.
• A narrative synthesis of findings was performed, alongside a review of major international guidelines.

Main Results:

• 85% of 315 studies concluded that shorter antibiotic courses are equivalent or non-inferior.
• Robust evidence supports shorter durations for adult bacterial sinusitis, community-acquired pneumonia, uncomplicated cellulitis, and certain urinary tract and intra-abdominal infections.
• Limited trials focused on severe infections (e.g., bloodstream infections) or were conducted in low- and middle-income countries (LMICs); only 15% of studies had low risk of bias.

Conclusions:

• Reducing antibiotic duration is a vital strategy for antibiotic stewardship and an active research area.
• Shorter antibiotic courses are appropriate for many bacterial infections, but more evidence is required for severe infections.
• Further research is needed in low- and middle-income settings to establish optimal antibiotic durations.