Antibiotic treatment with C-reactive protein (CRP)–guided duration or fixed 7-day duration were found to be non-inferior to 14 days of antibiotic treatment in patients with uncomplicated gram-negative bacteremia, Swiss researchers reported this week in JAMA. In a randomized controlled clinical trial involving more than 500 adults with uncomplicated bacteremia caused by gram-negative pathogens, rates of clinical failure for CRP–guided treatment and 7-day treatment compared with 14-day treatment met the non-inferiority criterion of 10%, the researchers reported. But they cautioned that interpretation of the results is limited by the large non-inferiority margin compared with the low observed event rate, along with low adherence and a wide range of treatment durations in the CRP group. The aim of the study was to evaluate whether individualized antibiotic durations guided by a biomarker can be a viable option for treating gram-negative bacteremia, a frequent community-acquired and healthcare-associated bloodstream infection. Antibiotic treatments for this infection typically range from 10 to 14 days, but evidence has been mounting that 7 days of antibiotics is an option. According to the authors of the study, however, these fixed durations of antibiotics cannot account for differences in patients, pathogens, and sources of infections. In some cases, patients may require longer therapy, while other patients may improve quickly and need less antibiotic support. Finding a strategy to tailor antibiotic therapy could help reduce unnecessary antibiotic exposure that drives the emergence of resistance and increase the risk for adverse events.

 

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