Seven Days of Antibiotic Therapy Appears Adequate for Most Bloodstream Infections Regardless of Procalcitonin Levels: JAMA
A new study published in the Journal of American Medical Association showed that in individuals with bloodstream infections, higher procalcitonin (PCT) levels on day 7 were linked to higher 90-day mortality.
7 days of antibiotics were shown to be noninferior to 14 days in patients with bacteremia, according to the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) experiment. It is unclear, nonetheless, if a longer course of treatment would be advantageous for individuals with elevated blood procalcitonin (PCT) levels on day seven of therapy. Thus, this study determined if patients treated with 7 vs. 14 days of antibiotics had a higher death rate if their serum PCT level was raised on day 7 of bacteremia.
This cohort research was a planned secondary analysis of the BALANCE experiment, a multicenter randomized clinical trial that spanned from 2014 to 2023. Patients were monitored for ninety days following study enrollment, and serum was taken on day seven of bacteremia. Patients' serum samples were taken seven days after starting antibiotics; PCT levels were then measured using an assay based on antibodies, so physicians were not able to access them. Patients were randomly assigned to take antibiotics for 7 or 14 days. The treating team has the last say on the choice, dosage, and administration of antibiotics.
A total of 125 patients were included in this investigation. 65 individuals (52%) had low PCT levels (<250 pg/mL) and 60 (48%) had high PCT levels (≥250 pg/mL) on day 7. Community-acquired bacteremia was more common in the high PCT group, which was also older and had more comorbidities.
The high PCT group had a higher 90-day mortality rate of 21.6% (13 of 60) compared to 6.2% (4 of 65) (absolute risk difference [ARD] 15.5%; 95% CI, 3.6%-27.5%). 90-day mortality among patients with high PCT levels did not change between those who used antibiotics for 7 and 14 days (ARD, −19.9%; 95% CI, −1.7 to 41.7).
Overall, a high day 7 serum PCT level was linked to a higher risk of 90-day all-cause death in this planned secondary analysis of the original BALANCE study, which included 125 participants. However, a longer course of antibiotic medication did not help individuals with a high day 7 serum PCT level.
Source:
Ramendra, R., Wright, J. K., Kain, K. C., Kim, B., Mishra, H., Zhong, K., Aslanian, P., Carignan, A., Conly, J., Detsky, M., Duan, E., Evans, G., Friedrich, J. O., Lamontagne, F., Lauzier, F., Macfadden, D. R., Marshall, J., McIntyre, L., Muscedere, J., … Daneman, N. (2026). Procalcitonin to guide 7 vs 14 days of antibiotics in bloodstream infections: A secondary analysis of the BALANCE trial: A secondary analysis of the BALANCE trial. JAMA Network Open, 9(6), e2620973. https://doi.org/10.1001/jamanetworkopen.2026.20973
