Outcomes of 7 days and 14 days antibiotic therapy for bloodstream infection comparable: NEJM

A new study published in the New England Journal of Medicine showed that antibiotic therapy for 7 days was not inferior to treatment for 14 days among patients hospitalized with bloodstream infections. An estimated 2.9 million people worldwide die from bloodstream infections each year, making it one of the most serious forms of bacterial diseases. Although the recommended period of antibiotic therapy is 14 days or more, nothing is known about how long it should last for bloodstream infections. Shorter antibiotic treatments raise the possibility of clinical failure or infection recurrence.

The BALANCE Investigators from the University of Toronto decided to find out if the mortality rates following 7 and 14 days of antibiotic use were comparable. Also, they expected that shortened antibiotic duration might lower adverse events, antibiotic exposure, and resistant organism infections.

This research randomly allocated hospitalized patients with bloodstream infections, including the ones in the intensive care unit [ICU], to receive antibiotic therapy for 7 or 14 days. The treating team made decisions about the choice, dosage, and route of antibiotics. The patients with severe immunosuppression, foci that needed ongoing care, single cultures that could have been contaminated, or cultures that produced Staphylococcus aureus were not included. With a noninferiority margin of 4 percentage points, the main outcome was mortality from any cause within 90 days after the bloodstream infection diagnosis.