New England Journal of Medicine· 2015Q1
Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection
- 740citations
- Q1SCImago
- 2015year
Short summary
A fixed 4-day course of antibiotics proved as effective as a longer, symptom-guided course (median 8 days) for treating complicated intraabdominal infections after source control, with no significant difference in surgical-site infections, recurrent infections, or death within 30 days.
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Key points
- Fixed 4-day antibiotic therapy was similar in efficacy to longer, symptom-guided therapy (median 8 days) for intraabdominal infections.
- The primary outcome (surgical-site infection, recurrent infection, or death within 30 days) occurred in 21.8% of the short-course group vs. 22.3% of the control group.
- The median duration of antibiotic therapy was 4.0 days in the experimental group versus 8.0 days in the control group.
- No significant differences were observed in individual components of the primary outcome or other secondary outcomes between groups.
AI-generated from the title and abstract; the full text is not read.
Abstract
BACKGROUND: The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS: We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections. RESULTS: Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, -0.5 percentage point; 95% confidence interval [CI], -7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, -4.0 days; 95% CI, -4.7 to -3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes. CONCLUSIONS: In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.).
The authors' abstract, as published at the source. New England Journal of Medicine, 2015 · DOI ↗
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Field: Emergency Medicine
Emergency MedicineMedicine