Individualizing Antibiotic Duration for Patients with Gram-Negative Bacteremia

Using C-reactive protein levels to guide treatment was as effective as a fixed 2-week antibiotic course.

Longer courses of antibiotics increase risk for adverse effects, drive emergence of resistance, and lead to lengthier hospitalizations and higher costs. Perhaps individualizing antibiotic durations via biomarker-assisted guidance could limit antibiotic exposure while preserving desired outcomes.

In a 2-year multicenter Swiss trial of 500 adults with gram-negative bacteremia, researchers randomized patients (at day 5 of antibiotic therapy) to individualized C-reactive protein (CRP)−guided treatment duration, fixed 7-day duration, or fixed 14-day duration (control group). For patients in the CRP-guided group, antibiotic therapy was discontinued when serum CRP had decreased 75% from peak value and the patient had been afebrile for 48 hours. At …

Reviewing Author

Andrew S. Parsons, MD, MPH

Disclosures

Consultant/Advisory BoardNEJM Healer Advisory Group; Aquifer Clinical Excellence; NBME Clinical Reasoning

Grant/Research SupportSouthern Group on Educational Affairs (SGEA)

Editorial BoardsDiagnosis

Leadership Positions in Professional SocietiesUndergraduate Medical Education (UME) Section Chair, Southern Group on Educational Affairs (SGEA); Chair of Early Career Physicians, American College of Physicians (ACP), Virginia Chapter

Andrew S. Parsons, MD, MPH

Disclosures

Consultant/Advisory BoardNEJM Healer Advisory Group; Aquifer Clinical Excellence; NBME Clinical Reasoning

Grant/Research SupportSouthern Group on Educational Affairs (SGEA)

Editorial BoardsDiagnosis

Individualizing Antibiotic Duration for Patients with Gram-Negative Bacteremia

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Reviewing Author