How Long Should Patients with Bloodstream Infections Receive Antiobiotics?

BALANCE Investigators, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2024; in press.

The optimal duration of antibiotic therapy for bloodstream infections is not clear based on available data. Concerns have been expressed that shorter durations of treatment might result in treatment failures and emergence of resistant organisms.

The BALANCE trial was a prospective, randomized, controlled non-inferiority trial that compared outcomes of patients (n = 3,608) with bloodstream infections treated with 7 or 14 days of antimicrobial therapy. Choice of antimicrobial drug(s) was left to the discretion of treating clinicians.

Patients who were immunosuppressed or who were diagnosed with single positive blood cultures showing potential contaminants or S. aureus were excluded.

The main outcome of interest was death from any cause during a 90-day follow up interval.

The data analysis showed that urinary tract infection was the most common cause of bacteremia.

Mortality for patients receiving 7 days of therapy was 14.5% and 16.1% for patients receiving 14 days of therapy. The authors concluded that treatment for seven days was non-inferior to treatment for 14 days.