Duration of therapy recommended for bacteraemic illness varies widely amongst clinicians

Mostafa Alwan, Joshua S. Davis, Nick Daneman, Robert Fowler, Yahya Shehabi, Benjamin Rogers

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    The optimum duration of antimicrobial therapy would eradicate infection whilst minimising potential adverse drug effects to the patient. Australian and New Zealand infectious diseases (ID) and ICU specialists were surveyed regarding their recommended duration of antibiotic treatment for five common bacteraemic syndromes. A total of 239 clinicians responded to the survey (15.5% ICU and 84.5% ID). Overall, the most common reported durations were 7 (33.7%), 10 (25.9%) and 14 (26.0%) days, with 46% of responses recommending ≤7 days. Most respondents (>75% for each characteristic) would not modify duration based on host characteristics such as patient age or co-morbidities. ID physicians recommended longer durations than ICU physicians for all five syndromes (ID, median 10, IQR 7–14, range 1–28 days; ICU, median 7, IQR 5–10, range 2–21 days). Across all respondents, the median (IQR) duration for each syndrome was: CVC-BSI, 7 (7–10) days; bacteraemic pneumonia, 7 (7–10) days; bacteraemic UTI, 10 (7–14) days; bacteraemic IAI, 7 (7–12) days; and bacteraemic SSTI, 10 (7–14) days. Marked variation exists amongst clinicians’ recommended duration of antibiotic treatment for BSI. A proportion of clinicians recommend therapy of ≤7 days at present (33.3–59.7% across scenarios). Patient characteristics are not strongly considered in the decision on therapy duration. This survey was undertaken as preparatory work for initiation of the BALANCE study, an ongoing randomised trial comparing 7 days with 14 days of therapy for BSI, providing an evidence base to inform best clinical treatment for this patient population.

    Original languageEnglish
    Pages (from-to)184-188
    Number of pages5
    JournalInternational Journal of Antimicrobial Agents
    Volume54
    Issue number2
    Early online date11 May 2019
    DOIs
    Publication statusPublished - Aug 2019

    Fingerprint

    Communicable Diseases
    Therapeutics
    Anti-Bacterial Agents
    Physicians
    New Zealand
    Pneumonia
    Morbidity
    Surveys and Questionnaires
    Infection
    Pharmaceutical Preparations
    Population

    Cite this

    Alwan, Mostafa ; Davis, Joshua S. ; Daneman, Nick ; Fowler, Robert ; Shehabi, Yahya ; Rogers, Benjamin. / Duration of therapy recommended for bacteraemic illness varies widely amongst clinicians. In: International Journal of Antimicrobial Agents. 2019 ; Vol. 54, No. 2. pp. 184-188.
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    abstract = "The optimum duration of antimicrobial therapy would eradicate infection whilst minimising potential adverse drug effects to the patient. Australian and New Zealand infectious diseases (ID) and ICU specialists were surveyed regarding their recommended duration of antibiotic treatment for five common bacteraemic syndromes. A total of 239 clinicians responded to the survey (15.5{\%} ICU and 84.5{\%} ID). Overall, the most common reported durations were 7 (33.7{\%}), 10 (25.9{\%}) and 14 (26.0{\%}) days, with 46{\%} of responses recommending ≤7 days. Most respondents (>75{\%} for each characteristic) would not modify duration based on host characteristics such as patient age or co-morbidities. ID physicians recommended longer durations than ICU physicians for all five syndromes (ID, median 10, IQR 7–14, range 1–28 days; ICU, median 7, IQR 5–10, range 2–21 days). Across all respondents, the median (IQR) duration for each syndrome was: CVC-BSI, 7 (7–10) days; bacteraemic pneumonia, 7 (7–10) days; bacteraemic UTI, 10 (7–14) days; bacteraemic IAI, 7 (7–12) days; and bacteraemic SSTI, 10 (7–14) days. Marked variation exists amongst clinicians’ recommended duration of antibiotic treatment for BSI. A proportion of clinicians recommend therapy of ≤7 days at present (33.3–59.7{\%} across scenarios). Patient characteristics are not strongly considered in the decision on therapy duration. This survey was undertaken as preparatory work for initiation of the BALANCE study, an ongoing randomised trial comparing 7 days with 14 days of therapy for BSI, providing an evidence base to inform best clinical treatment for this patient population.",
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    Duration of therapy recommended for bacteraemic illness varies widely amongst clinicians. / Alwan, Mostafa; Davis, Joshua S.; Daneman, Nick; Fowler, Robert; Shehabi, Yahya; Rogers, Benjamin.

    In: International Journal of Antimicrobial Agents, Vol. 54, No. 2, 08.2019, p. 184-188.

    Research output: Contribution to journalArticleResearchpeer-review

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