Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis
The optimal duration of antibiotic therapy for bloodstream infections (BSIs) remains uncertain. This meta-analysis with trial sequential analysis (TSA) compared the efficacy and safety of 7-day versus 14-day antibiotic courses in adults. A systematic search of PubMed, Embase, and Cochrane Library id...
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| Language: | English |
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Elsevier
2025-09-01
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| Series: | Journal of Infection and Public Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034125002011 |
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| author | Chen-Wei Wu Chih-Cheng Lai Jheng-Yan Wu Mei-Chuan Lee |
| author_facet | Chen-Wei Wu Chih-Cheng Lai Jheng-Yan Wu Mei-Chuan Lee |
| author_sort | Chen-Wei Wu |
| collection | DOAJ |
| description | The optimal duration of antibiotic therapy for bloodstream infections (BSIs) remains uncertain. This meta-analysis with trial sequential analysis (TSA) compared the efficacy and safety of 7-day versus 14-day antibiotic courses in adults. A systematic search of PubMed, Embase, and Cochrane Library identified four randomized controlled trials (4794 patients). The 7-day course showed similar 90-day all-cause mortality (RR 0.94, 95 % CI 0.79–1.12, p = 0.51) and bacteremia relapse rates (RR 1.15, 95 % CI 0.80–1.64, p = 0.45) compared to 14 days. No significant differences were found in adverse events, including acute kidney injury, diarrhea, allergic reactions, and Clostridioides difficile infections. TSA indicated an insufficient information size. While 90-day mortality is an objective endpoint, it may not fully capture clinical recovery or long-term sequelae. Nonetheless, the findings indicate that a 7-day antibiotic course achieves outcomes comparable to a 14-day regimen in non–high-risk patients, supporting shorter durations consistent with antimicrobial stewardship. |
| format | Article |
| id | doaj-art-b63d268d290d4a8a97a2c821ca34ee57 |
| institution | Kabale University |
| issn | 1876-0341 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj-art-b63d268d290d4a8a97a2c821ca34ee572025-08-20T03:58:00ZengElsevierJournal of Infection and Public Health1876-03412025-09-0118910285210.1016/j.jiph.2025.102852Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysisChen-Wei Wu0Chih-Cheng Lai1Jheng-Yan Wu2Mei-Chuan Lee3Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, TaiwanDepartment of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, TaiwanDepartment of Nutrition, Chi Mei Medical Center, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan; Corresponding author at: Department of pharmacy, Chi-Mei Medical Center, Tainan, Taiwan, No 901, Zhonghua Rd, Yong Kang District, Tainan City, Taiwan.The optimal duration of antibiotic therapy for bloodstream infections (BSIs) remains uncertain. This meta-analysis with trial sequential analysis (TSA) compared the efficacy and safety of 7-day versus 14-day antibiotic courses in adults. A systematic search of PubMed, Embase, and Cochrane Library identified four randomized controlled trials (4794 patients). The 7-day course showed similar 90-day all-cause mortality (RR 0.94, 95 % CI 0.79–1.12, p = 0.51) and bacteremia relapse rates (RR 1.15, 95 % CI 0.80–1.64, p = 0.45) compared to 14 days. No significant differences were found in adverse events, including acute kidney injury, diarrhea, allergic reactions, and Clostridioides difficile infections. TSA indicated an insufficient information size. While 90-day mortality is an objective endpoint, it may not fully capture clinical recovery or long-term sequelae. Nonetheless, the findings indicate that a 7-day antibiotic course achieves outcomes comparable to a 14-day regimen in non–high-risk patients, supporting shorter durations consistent with antimicrobial stewardship.http://www.sciencedirect.com/science/article/pii/S1876034125002011Bloodstream infectionsAntibiotic durationMeta-analysisTrial sequential analysisAntimicrobial stewardship |
| spellingShingle | Chen-Wei Wu Chih-Cheng Lai Jheng-Yan Wu Mei-Chuan Lee Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis Journal of Infection and Public Health Bloodstream infections Antibiotic duration Meta-analysis Trial sequential analysis Antimicrobial stewardship |
| title | Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis |
| title_full | Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis |
| title_fullStr | Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis |
| title_full_unstemmed | Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis |
| title_short | Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis |
| title_sort | clinical outcomes and safety of 7 day versus 14 day antibiotic therapy for bloodstream infections in adults a systematic review and meta analysis with trial sequential analysis |
| topic | Bloodstream infections Antibiotic duration Meta-analysis Trial sequential analysis Antimicrobial stewardship |
| url | http://www.sciencedirect.com/science/article/pii/S1876034125002011 |
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