International clinical trial suggests 7-day antibiotic treatment is as effective as longer treatments

An international clinical trial led by researchers at Sunnybrook has found that treating hospitalized patients with bloodstream infection with antibiotics for seven days is non-inferior to 14-day treatment.

The results of the study were recently published in the New England Journal of Medicine.

Bloodstream infections are common and serious, responsible for nearly three million deaths per year globally. Early antibiotic treatment plays a critical role in the survival of patients with bloodstream infections, but the optimal duration of treatment has been understudied. The Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) Randomized Clinical Trial, tested seven versus 14 days of antibiotic treatment for patients with bloodstream infection in 74 hospitals across seven countries. The primary outcome was 90-day mortality.

“Despite how common and lethal bloodstream infections are, many aspects of treatment, like the optimal duration of antibiotic therapy, have been understudied,” explains Dr. Nick Daneman, scientist in the Tory Trauma Research Program at Sunnybrook Research Institute and co-principal investigator of the BALANCE Trial. “Our aim was to determine if shorter or longer treatment durations had an impact on patient outcomes, to help inform future treatment recommendations.”

Traditionally, short-course antibiotic treatment has raised concerns that insufficient durations could result in clinical failure or relapsing infection. Conversely, the harms of excessive treatment duration include avoidable adverse events such as the development of resistance among non-target bacteria.

The BALANCE Trial included 3608 patients, who were randomized in the intention-to-treat analysis. The primary outcome, death at 90 days, occurred in 261 (14.5%) patients receiving 7-day and in 286 (16.1%) receiving 14-day treatment, demonstrating that shorter duration treatment was as effective.

“The results of the trial tell us that one week of antibiotic therapy is just as good as two weeks,” adds Dr. Rob Fowler, senior scientist, chief of the Tory Trauma Program and co-principal investigator of the study. “Additionally, these results can help inform decisions that improve systems of care like increasing savings in drug costs and reducing antimicrobial resistance at an individual and population-level.”

The BALANCE Randomized Clinical Trial was made possible with funding support from the Canadian Institutes of Health Research, Health Research Council of New Zealand, Australian National Medical Research Council, Physicians Services Incorporated Ontario and Ontario Ministry of Health and Long-term Care Innovation Fund.