An international clinical trial involving Monash researchers – of more than 3600 patients in 74 hospitals – has shown that a traditional long course of antibiotics for bloodstream infection are not necessary.
Associate Professor Benjamin Rogers, from Monash’s Centre for Inflammatory Diseases and Monash Health, said deaths from bloodstream infection totalled around three million deaths per year globally and was a serious, life-threatening condition, so the “tradition” for decades has been to administer longer treatments.
“Patients with bloodstream infections are often very sick at diagnosis and even with rapid administration of antibiotics they may take a while to start improving,” he said. “The long-standing practice has been to treat them for two weeks with antibiotics. The key learning from our study is that it's not how sick you are at the start that determines how long you should be treated for.”
The results of the study – the largest ever randomised trial of bloodstream infection - are now published in the New England Journal of Medicine.
It shows that treating adult patients hospitalised with sepsis due to bloodstream infection with a one-week short course of antibiotics is no different to a traditional two-week course. The research was led by the Sunnybrook Research Institute in Canada, with the Australian sites co-ordinated by Monash Health and Monash University, supported by the Australian National Health and Medical Research Council.
Associate Professor Rogers said using fewer antibiotics would help to stem rising antibiotic resistance, reduce the number of patients who may suffer side effects and may save costs for our health system. This week is World Antibiotic Awareness Week.
Associate Professor Rogers said antibiotics were extremely important at early stages of infections – “but what we didn't know is that in many patients you could actually just stop them after a week”. He said it was a “very robust finding” from a large randomised controlled trial. The final measure was the number of patients who were alive 90 days after the infection. “We showed that whether you had one week or two weeks of treatment, a similar proportion of people were still alive,” he said.
One of the principal investigators in the trial, Dr Nick Daneman, of the Tory Trauma Research Program at Sunnybrook, said sepsis and antibiotics were under-researched.
“Our aim was to determine if shorter or longer treatment durations had an impact on patient outcomes to help inform future treatment recommendations.”
The trial – called BALANCE (Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness) – included 3608 patients. Death at 90 days occurred in 14.5 per cent of those who were randomised to a seven day treatment and 16.1 per cent of those who were randomised to a 14 day treatment. The Australian and Canadian researchers were joined by researchers from New Zealand, the Middle East and Europe.
“One week of antibiotic therapy is just as good as two weeks,” said Dr. Rob Fowler, chief scientist of Sunnybrook’s Tory Trauma Program and co-principal investigator. “These results can help inform decisions that improve systems of care like increasing savings in drug costs and reducing antimicrobial resistance at an individual and population-level.”
To view the research paper, please visit: https://www.nejm.org/doi/full/10.1056/NEJMoa2404991
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RESEARCHER
Associate Professor Benjamin Rogers Monash’s Centre for Inflammatory Diseases and Monash Health
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