
Shorter-duration antibiotic courses show similar efficacy for bloodstream infections and reduce the length of hospitals stays compared with longer courses, according to a study published yesterday in eClinical Medicine.
The systematic review and meta-analysis, conducted by researchers from China and Singapore, examined 11 randomized controlled trials published from 2006 through 2025 and involving 5,505 immunocompetent patients with bloodstream infections. Five trials compared the efficacy of 10-day antibiotic regimens for bloodstream infections versus 14-day regimens, 5 compared 7 days versus 14 days, and 1 trial compared 7 days versus 10 days.
The study authors note that while clinicians may be more inclined to choose longer antibiotic courses for bloodstream infections, recent studies have provided insight into the efficacy of shorter courses. "However, the optimal duration of antibiotic treatment for bacterial bloodstream infections remains a subject of intense debate. There is a lack of clear and definitive guidelines, and clinical practice varies widely," they wrote.
No difference in mortality, treatment failure, hospital readmission
The meta-analysis found little to no difference in mortality (risk ratio [RR], 0.91; 95% confidence interval [CI], 0.79 to 1.05; moderate certainty), treatment failure (RR, 1.08; 95% CI, 0.69 to 1.68; moderate certainty), and relapse rates (RR, 1.15; 95% CI, 0.82 to 1.63; moderate certainty) between shorter- and longer-duration antibiotics.
Compared with longer-duration antibiotics, shorter-duration antibiotics did not increase hospital readmission (RR, 0.91; 95% CI, 0.75 to 1.1; high certainty) but did reduce the length of hospital stay (mean difference, −3.04 days; 95% CI, −3.9 to −2.18; high certainty). Consistent effects were observed across age-groups and bacterial types.
Very low–certainty evidence showed uncertainty on the question of whether shorter-duration antibiotics decrease any adverse events (RR, 1.0; 95% CI, 0.76 to 1.32) and serious adverse events (RR, 0.67; 95% CI, 0.39 to 1.14) compared with longer-duration antibiotics.
"Our study found that there were probably no differences between shorter-duration and longer-duration antibiotics in mortality, treatment failure, relapse, hospital re-admission and clinical cure, while shorter-duration antibiotics were associated with a shorter hospital stay," the authors concluded. "Therefore, the above findings support the use of shorter-duration antibiotics in the bloodstream infections patient population."