Are 7 Days of Antibiotics as Good as 14 Days for Bloodstream Infections?

Compared with longer courses of antibiotics, shorter courses lead to equivalent or better outcomes in many patients with uncomplicated infectious syndromes. However, knowing whether the “shorter is better” mantra also applies to patients with bloodstream infections has been hindered by underwhelming results from small trials. Now, results of the long-waited BALANCE trial inform the optimal duration of therapy for some patients with bloodstream infections (NEJM JW Gen Med Jan 1 2025 and N Engl J Med 2024 Nov 20; [e-pub]).

In this multinational noninferiority trial, researchers analyzed data from 3600 hospitalized patients (median age, 70) with certain bloodstream infections who were randomized to receive 7 or 14 days of antibiotics — choice o…