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Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis

WHAT IS KNOWN AND OBJECTIVE: Gram‐negative bacteremia remains a major health problem around the world. The optimal duration of antibiotic treatment has been poorly defined, and there are significant differences of opinion between clinicians. We conducted this systematic review and meta‐analysis to c...

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Autores principales: Li, Xiaoming, Liu, Chao, Mao, Zhi, Li, Qinglin, Qi, Shuang, Zhou, Feihu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820952/
https://www.ncbi.nlm.nih.gov/pubmed/32981149
http://dx.doi.org/10.1111/jcpt.13277
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author Li, Xiaoming
Liu, Chao
Mao, Zhi
Li, Qinglin
Qi, Shuang
Zhou, Feihu
author_facet Li, Xiaoming
Liu, Chao
Mao, Zhi
Li, Qinglin
Qi, Shuang
Zhou, Feihu
author_sort Li, Xiaoming
collection PubMed
description WHAT IS KNOWN AND OBJECTIVE: Gram‐negative bacteremia remains a major health problem around the world. The optimal duration of antibiotic treatment has been poorly defined, and there are significant differences of opinion between clinicians. We conducted this systematic review and meta‐analysis to compare the clinical outcomes of short‐course and long‐course treatments in patients with uncomplicated gram‐negative bacteremia. METHODS: We searched public databases (PubMed, EMBASE and Cochrane Library) to identify eligible studies. The primary outcomes were all‐cause mortality and the incidence of recurrent bacteremia through day 30. We used the Cochrane risk of bias assessment tool to evaluate the risk of bias for randomized controlled trials (RCTs) and the Newcastle‐Ottawa Scale for non‐RCTs. RESULTS AND DISCUSSION: Six studies involving 2689 patients were included in the systematic review and meta‐analysis. No significant difference was found between short‐course and long‐course antibiotic treatments in 30‐day mortality (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.65‐1.13; P = .26), 30‐day recurrent bacteremia (RR 1.07; 95% CI 0.68‐1.67; P = .78), 90‐day mortality (RR 0.84; 95% CI 0.57‐1.24; P = .38), 90‐day recurrent bacteremia (RR 0.98; 95% CI 0.50‐1.89; P = .94), adverse events (RR 1.14; 95% CI 0.89‐1.45; P = .30), Clostridium difficile infection (RR 0.86; 95% CI 0.40‐1.86; P = .71) or resistance development (RR 1.19; 95% CI 0.66‐2.14; P = .57). WHAT IS NEW AND CONCLUSION: Short‐course was non‐inferior to long‐course antibiotic treatments for patients with uncomplicated gram‐negative bacteremia. Considering the drug‐related side effects and cost‐effectiveness, a shorter duration of antibiotic treatment may be preferable for this particular population. However, additional high‐quality RCTs are needed to further assess whether a shorter course of antibiotic treatment is of greater benefit for patients with uncomplicated gram‐negative bacteremia.
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spelling pubmed-78209522021-01-26 Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis Li, Xiaoming Liu, Chao Mao, Zhi Li, Qinglin Qi, Shuang Zhou, Feihu J Clin Pharm Ther Original Articles WHAT IS KNOWN AND OBJECTIVE: Gram‐negative bacteremia remains a major health problem around the world. The optimal duration of antibiotic treatment has been poorly defined, and there are significant differences of opinion between clinicians. We conducted this systematic review and meta‐analysis to compare the clinical outcomes of short‐course and long‐course treatments in patients with uncomplicated gram‐negative bacteremia. METHODS: We searched public databases (PubMed, EMBASE and Cochrane Library) to identify eligible studies. The primary outcomes were all‐cause mortality and the incidence of recurrent bacteremia through day 30. We used the Cochrane risk of bias assessment tool to evaluate the risk of bias for randomized controlled trials (RCTs) and the Newcastle‐Ottawa Scale for non‐RCTs. RESULTS AND DISCUSSION: Six studies involving 2689 patients were included in the systematic review and meta‐analysis. No significant difference was found between short‐course and long‐course antibiotic treatments in 30‐day mortality (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.65‐1.13; P = .26), 30‐day recurrent bacteremia (RR 1.07; 95% CI 0.68‐1.67; P = .78), 90‐day mortality (RR 0.84; 95% CI 0.57‐1.24; P = .38), 90‐day recurrent bacteremia (RR 0.98; 95% CI 0.50‐1.89; P = .94), adverse events (RR 1.14; 95% CI 0.89‐1.45; P = .30), Clostridium difficile infection (RR 0.86; 95% CI 0.40‐1.86; P = .71) or resistance development (RR 1.19; 95% CI 0.66‐2.14; P = .57). WHAT IS NEW AND CONCLUSION: Short‐course was non‐inferior to long‐course antibiotic treatments for patients with uncomplicated gram‐negative bacteremia. Considering the drug‐related side effects and cost‐effectiveness, a shorter duration of antibiotic treatment may be preferable for this particular population. However, additional high‐quality RCTs are needed to further assess whether a shorter course of antibiotic treatment is of greater benefit for patients with uncomplicated gram‐negative bacteremia. John Wiley and Sons Inc. 2020-09-27 2021-02 /pmc/articles/PMC7820952/ /pubmed/32981149 http://dx.doi.org/10.1111/jcpt.13277 Text en © 2020 The Authors. Journal of Clinical Pharmacy and Therapeutics published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Li, Xiaoming
Liu, Chao
Mao, Zhi
Li, Qinglin
Qi, Shuang
Zhou, Feihu
Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis
title Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis
title_full Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis
title_fullStr Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis
title_full_unstemmed Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis
title_short Short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: A systematic review and meta‐analysis
title_sort short‐course versus long‐course antibiotic treatment in patients with uncomplicated gram‐negative bacteremia: a systematic review and meta‐analysis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820952/
https://www.ncbi.nlm.nih.gov/pubmed/32981149
http://dx.doi.org/10.1111/jcpt.13277
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