title: Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis.
abstract: BACKGROUND
  The optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy have been demonstrated to be as effective as longer durations for many common infections; similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, resistance and costs.
  
  
  METHODS
  A search of the MEDLINE, EMBASE and COCHRANE databases was conducted for the years 1947-2010. Controlled trials were identified that randomized patients to shorter versus longer durations of treatment for bacteremia, or the infectious foci most commonly causing bacteremia in critically ill patients (catheter-related bloodstream infections (CRBSI), intra-abdominal infections, pneumonia, pyelonephritis and skin and soft-tissue infections (SSTI)).
  
  
  RESULTS
  Twenty-four eligible trials were identified, including one trial focusing exclusively on bacteremia, zero in catheter related bloodstream infection, three in intra-abdominal infection, six in pyelonephritis, thirteen in pneumonia and one in skin and soft tissue infection. Thirteen studies reported on 227 patients with bacteremia allocated to 'shorter' or 'longer' durations of treatment. Outcome data were available for 155 bacteremic patients: neonatal bacteremia (n = 66); intra-abdominal infection (40); pyelonephritis (9); and pneumonia (40). Among bacteremic patients receiving shorter (5-7 days) versus longer (7-21 days) antibiotic therapy, no significant difference was detected with respect to rates of clinical cure (45/52 versus 47/49, risk ratio 0.88, 95% confidence interval [CI] 0.77-1.01), microbiologic cure (28/28 versus 30/32, risk ratio 1.05, 95% CI 0.91-1.21), and survival (15/17 versus 26/29, risk ratio 0.97, 95% CI 0.76-1.23).
  
  
  CONCLUSIONS
  No significant differences in clinical cure, microbiologic cure and survival were detected among bacteremic patients receiving shorter versus longer duration antibiotic therapy. An adequately powered randomized trial of bacteremic patients is needed to confirm these findings.
authors.affiliation: Department of Medicine, University of Toronto, 1 Kings College Circle, O, M5S 1A8, Canada.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Havey
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.forename: Nick
authors.initials: N
authors.lastname: Daneman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D055499:Catheter-Related Infections / Q000188:drug therapy; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D011704:Pyelonephritis / Q000188:drug therapy; D018461:Soft Tissue Infections / Q000188:drug therapy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Lancet. 2002 Sep 14;360(9336):835-41
references.pmid: 12243918
references.citation: Am J Ther. 1999 Jul;6(4):217-22
references.pmid: 11329100
references.citation: J Perinatol. 2003 Jul-Aug;23(5):372-7
references.pmid: 12847531
references.citation: Clin Infect Dis. 2011 May;52(10):1232-40
references.pmid: 21507920
references.citation: Am J Med. 2007 Sep;120(9):783-90
references.pmid: 17765048
references.citation: J Urol. 1985 Feb;133(2):176-8
references.pmid: 3881598
references.citation: Int J Antimicrob Agents. 1995 Sep;6(1):27-30
references.pmid: 18611681
references.citation: Chest. 2000 Jul;118(1):146-55
references.pmid: 10893372
references.citation: Crit Care Med. 2006 Jun;34(6):1589-96
references.pmid: 16625125
references.citation: Int J Antimicrob Agents. 2007 Nov;30 Suppl 1:S76-9
references.pmid: 17826038
references.citation: Eur J Pediatr. 2000 Dec;159(12):878-84
references.pmid: 11131342
references.citation: Clin Infect Dis. 2006 Apr 15;42(8):1118-26
references.pmid: 16575729
references.citation: Clin Infect Dis. 2003 Sep 15;37(6):752-60
references.pmid: 12955634
references.citation: J Perinatol. 2000 Oct-Nov;20(7):421-6
references.pmid: 11076325
references.citation: Arch Intern Med. 2004 Aug 9-23;164(15):1669-74
references.pmid: 15302637
references.citation: Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72
references.pmid: 17278083
references.citation: Surg Infect (Larchmt). 2006 Oct;7(5):419-32
references.pmid: 17083308
references.citation: Pediatrics. 2006 Jan;117(1):e84-9
references.pmid: 16326693
references.citation: Ann Fr Anesth Reanim. 2009 Jan;28(1):16-23
references.pmid: 19097848
references.citation: Int J Antimicrob Agents. 2011 Dec;38(6):480-5
references.pmid: 21982833
references.citation: Ann Intern Med. 1987 Mar;106(3):341-5
references.pmid: 3492950
references.citation: J Antimicrob Chemother. 2007 Jul;60(1):112-20
references.pmid: 17537866
references.citation: Arch Intern Med. 1989 Mar;149(3):533-6
references.pmid: 2919931
references.citation: Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416
references.pmid: 15699079
references.citation: J Antimicrob Chemother. 2003 Nov;52(5):849-52
references.pmid: 14519681
references.citation: J Antimicrob Chemother. 2004 Aug;54(2):515-23
references.pmid: 15269191
references.citation: Curr Med Res Opin. 2007 Nov;23(11):2637-45
references.pmid: 17880755
references.citation: Drugs. 2008;68(13):1841-54
references.pmid: 18729535
references.citation: BMJ. 2006 Jun 10;332(7554):1355
references.pmid: 16763247
references.citation: Clin Infect Dis. 1997 Mar;24(3):387-95
references.pmid: 9114190
references.citation: BMJ. 2004 Apr 3;328(7443):791
references.pmid: 15070633
references.citation: Clin Infect Dis. 2004 Sep 1;39 Suppl 3:S159-64
references.pmid: 15546111
references.citation: JAMA. 2009 Dec 2;302(21):2323-9
references.pmid: 19952319
references.citation: Clin Infect Dis. 2011 Mar 1;52(5):e103-20
references.pmid: 21292654
references.citation: Ann Intern Med. 1993 Aug 15;119(4):304-11
references.pmid: 8328740
references.citation: JAMA. 2003 Nov 19;290(19):2588-98
references.pmid: 14625336
references.citation: Gastroenterology. 1991 Jun;100(6):1737-42
references.pmid: 2019378
references.citation: Clin Infect Dis. 2010 Jan 15;50(2):133-64
references.pmid: 20034345
references.citation: Clin Infect Dis. 2009 Jul 1;49(1):1-45
references.pmid: 19489710
references.citation: Acta Paediatr Scand. 1981 Nov;70(6):885-8
references.pmid: 7324942
references.citation: Urology. 2008 Jan;71(1):17-22
references.pmid: 18242357
references.citation: J Trop Pediatr. 2006 Dec;52(6):427-32
references.pmid: 17030532
references.citation: Am J Respir Crit Care Med. 2001 Jun;163(7):1584-90
references.pmid: 11401878
references.citation: JAMA. 2000 Mar 22-29;283(12):1583-90
references.pmid: 10735395
references.citation: Curr Opin Infect Dis. 2007 Apr;20(2):177-81
references.pmid: 17496577
references.citation: Clin Ther. 2008 Oct;30(10):1859-68
references.pmid: 19014841
references.citation: Clin Infect Dis. 2008 Feb 15;46(4):491-6
references.pmid: 18194098
references.citation: Clin Infect Dis. 1997 Apr;24(4):584-602
references.pmid: 9145732
references.citation: Acta Med Scand. 1988;223(5):469-77
references.pmid: 3287839
references.citation: Clin Infect Dis. 2005 Nov 15;41(10):1373-406
references.pmid: 16231249
references.citation: Clin Infect Dis. 2011 Feb 1;52(3):e18-55
references.pmid: 21208910
references.citation: Clin Infect Dis. 2007 Aug 1;45(3):329-37
references.pmid: 17599310
references.citation: J Gastrointest Surg. 2008 Mar;12(3):592-600
references.pmid: 17846853
references.citation: Arch Intern Med. 2003 Apr 28;163(8):972-8
references.pmid: 12719208
references.citation: BMJ. 2003 Sep 6;327(7414):557-60
references.pmid: 12958120