Duration of antibiotic therapy for bacteremia: systematic review and meta-analysis
There was no statistically significant difference in the frequency of clinical and microbiological healing and survival in patients with bacteremia who received short (5-7 days) and standard duration (7-21 days) antibacterial therapy .
The optimal duration of antimicrobial therapy for blood infections has not yet been precisely determined. In a number of studies, it has been shown that shorter antibiotic prescription times are as effective as longer treatment for many common infectious diseases. These bacteremia data can provide hospitals with the opportunity to reduce antibiotic consumption, reduce the incidence of adverse events, control the development and spread of antibiotic resistance, and reduce the cost of treating patients.
Canadian researchers from the University of Toronto conducted a systematic review and meta-analysis in 2011, which aimed to compare the short and long-term use of antibiotics for bacteremia.
The search for controlled trials was performed in the international databases MEDLINE, EMBASE and the Cochrane register of controlled studies for the period from 1947 to 2010. The meta-analysis included randomized controlled trials comparing a duration vsshorter antibiotherapy for bacteremia or foci of infection in which bacteremia most often occurs in critically ill patients or in intensive care units (patients with blood infections associated with the catheter, int abdominal infections, pneumonia , pyelonephritis and skin and soft tissue infections).
Twenty-four studies were identified, including one study conducted exclusively in patients with bacteremia, no study in blood infections associated with the catheter, 3 studies in intra-abdominal infections, 6 studies in patients with pyelonephritis, 13 studies on patients with pneumonia and a study on patients with skin and soft tissue infections.
In 13 studies, 227 patients with bacteremia were identified who were divided into those receiving "shorter" and "longer" treatment. The results of the treatment were available for evaluation in 155 patients with bacteremia: bacteremia in the newborn (n = 66), intra-abdominal infections (n = 40), pyelonephritis (n = 9) and pneumonia (n = 40).
Among patients with bacteremia who received short-term antibiotic therapy (5-7 days) compared to the standard duration of antibiotic therapy (7-21 days), there was no significant difference in the frequency of clinical recovery (45/52 vs 47/49, risk ratio 0.88, 95% confidence interval (CI) 0.77-1.01), microbiological treatment (28/28 vs 30/32, risk ratio 1, 05, 95% CI 0.91-1.21) and survival (15/17 vs 26/29, risk ratio 0.97, 95% CI 0.76-1.23).
Thus, according to a systematic review and meta-analysis, there was no statistically significant difference in the frequency of clinical recovery, microbiological recovery and survival in patients with bacteremia who received short, standard antibiotic therapy. To confirm this point, it is necessary to conduct a large randomized study comparing the short and long term use of antibiotics in patients with bacteremia.