The results of multicenter, randomized clinical trial show that a 7-day course of antibiotics for patients hospitalized with bloodstream infections is non-inferior to a 14- day course, researchers reported at IDWeek 2024.

The trial, conducted at 74 hospitals in 7 countries, randomized 3,608 hospitalized patients with bloodstream infections to receive either 7 or 14 days of antibiotics, with antibiotic selection, dosing, and route of administration at the discretion of the treating team. The primary outcome was 90-day mortality, with a 4% absolute non-inferiority margin.

Similar outcomes in both groups

A total of 1,814 patients received a 7-day course of antibiotics, and 1,794 received a 14-day course. At enrollment, 55% of patients were in the intensive care unit (ICU) and 45% on hospital wards. Infections were community-onset (75.4%), hospital-acquired (13.4%), or ICU-acquired (11.2%). Bacteremia sources were most commonly the urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%).  

The primary outcome of 90-day mortality occurred in 14.5% of patients receiving 7 days of antibiotics and 16.1% of patients in the 14-day arm, for an absolute difference of –1.6% (95 % confidence interval [CI], –4.0% to 0.8%), demonstrating the non-inferiority of the 7-day treatment. The findings were generally consistent across secondary clinical outcomes and pre-specified patient, pathogen, and syndrome subgroups.

“These findings underscore the effectiveness of a shorter antibiotic regimen in patients with bloodstream infections, which is welcomed as we look to identify evidence-based prescribing guidelines for serious bacterial infections,” presenting author Nick Daneman, MD, clinician scientist in the Division of Infectious Diseases at Sunnybrook Health Sciences Centre and professor of Medicine at the University of Toronto, said in an IDWeek press release.

Including preset treatment orders in the electronic medical records of children with ear infections dramatically improved compliance with antibiotic treatment guidelines, researchers reported at IDWeek 2024.

In a study conducted at the University of Colorado/Children’s Hospital Colorado, researchers analyzed data on 34,324 children aged 61 days to 18 months who visited emergency and urgent care centers in the health system for acute otitis media (AOM) from January 2019 to September 2023. Their aim was to assess the effectiveness of a bundled intervention for AOM that included an electronic health record (EHR) order set (implemented in April 2021) that pre-selected a 5-day antibiotic course for children 24 months and older and a local clinical care pathway (implemented in December 2022) that encouraged observation and pain management for children with non-severe AOM. 

Presenting author Joana Dimo, DO, a doctoral fellow at the University of Colorado, said the bundle was developed to address a common problem in antibiotic prescribing for AOM: while most cases (up to 75%) resolve without antibiotics, most children receive antibiotics, often for longer than needed.

“We noticed at our institution that children were being prescribed a lot of antibiotics for ear infections, and that the duration of antibiotics was longer than we thought necessary,” Dimo said at a press briefing.

80% improvement in compliance 

Although antibiotic prescribing remained high throughout the study (88% to 93%), the researchers found that after the EHR order set was implemented, compliance with the recommended antibiotic duration of 5 days rose from 3% to 83%. Rates of amoxicillin prescribing fell from 77% to 74%, a finding the study authors attribute to an amoxicillin shortage that began in October 2022.

“With this initiative, we were able to show a dramatic 80% improvement in prescribing 5-day durations of antibiotics for children over 2 with a simple and cost-effective strategy that did not lead to increased treatment failures or complications,” Dimo said, adding that shortening the antibiotic duration effectively cut antibiotic use for AOM in half.

• Nigeria, the country with the world’s highest malaria burden, yesterday received its first malaria vaccine delivery, according to a statement from Gavi, the Vaccine Alliance. The first phase of the country’s campaign will begin in November, targeting Kebbi and Beyelsa states, where malaria activity is especially high. Newly added to the country’s routine immunization schedule, the vaccine will be administered in children younger than 1 year old. The vaccine requires 4 doses. Nigeria is using the R21/Matrix-M vaccine, developed by Oxford University and made by the Serum Institute of India.
• Federal health officials yesterday said they have wrapped up their investigation into a Salmonella Enteritidis outbreak linked to eggs from Milo’s Poultry Farms, which were the subject of a recall. Since the initial announcement in early September, the Centers for Disease Control and Prevention (CDC) reported 28 more illnesses and 3 more affected states, bringing the outbreak total to 93 infections across 12 states. The latest illness onset was September 13. Thirty-four people were hospitalized, and no deaths were reported. 
• Two countries reported new polio cases this week, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI). Pakistan reported four more cases involving wild poliovirus type 1 (WPV1), lifting its total for the year to 32, a sharp rise compared with 2023. The patients are from Khyber Pakhtunkhwa and Sindh provinces and had paralysis onsets in August and September.  Elsewhere, Ethiopia reported two circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, putting its total for the year at 13. The patients are from Gambella and Somali provinces and had paralysis onsets in July.