Antimicrobial Treatment Duration in Sepsis and Serious Infections.

The Journal of Infectious Diseases
Lindsay M Busch, Sameer S Kadri

Abstract

Sepsis mortality has improved following advancements in early recognition and standardized management, including emphasis on early administration of appropriate antimicrobials. However, guidance regarding antimicrobial duration in sepsis is surprisingly limited. Decreased antibiotic exposure is associated with lower rates of de novo resistance development, Clostridioides difficile-associated disease, antibiotic-related toxicities, and health care costs. Consequently, data weighing safety versus adequacy of shorter treatment durations in sepsis would be beneficial. We provide a narrative review of evidence to guide antibiotic duration in sepsis. Evidence is significantly limited by noninferiority trial designs and exclusion of critically ill patients in many trials. Potential challenges to shorter antimicrobial duration in sepsis include inadequate source control, treatment of multidrug-resistant organisms, and pharmacokinetic alterations that predispose to inadequate antimicrobial levels. Additional studies specifically targeting patients with clinical indicators of sepsis are needed to guide measures to safely reduce antimicrobial exposure in this high-risk population while preserving clinical effectiveness.

References

Jun 13, 1998·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·J G BartlettT M File
Jul 28, 1999·JAMA : the Journal of the American Medical Association·L L LeapeD W Bates
Dec 10, 1999·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·J W WarrenW E Stamm
Mar 10, 2001·The New England Journal of Medicine·G R BernardUNKNOWN Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group
Sep 5, 2003·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Lala M DunbarJames B Kahn
Sep 25, 2003·Archives of Internal Medicine·Vance G FowlerEugene Z Oddone
Oct 2, 2003·The Journal of Antimicrobial Chemotherapy·Alberto CoronaA J Peter Wilson
Nov 20, 2003·JAMA : the Journal of the American Medical Association·Jean ChastreUNKNOWN PneumA Trial Group
Feb 9, 2005·American Journal of Respiratory and Critical Care Medicine·UNKNOWN American Thoracic Society, UNKNOWN Infectious Diseases Society of America
Jul 5, 2006·Annals of Internal Medicine·Sanjay Kaul, George A Diamond
Apr 1, 2009·Proceedings of the National Academy of Sciences of the United States of America·Xin HuangAlfred Ayala
May 19, 2009·Anesthesia and Analgesia·Christian TorgersenMartin W Dünser
Aug 22, 2009·Chest·Anand KumarUNKNOWN Cooperative Antimicrobial Therapy of Septic Shock Database Research Group
Nov 7, 2009·Critical Care Clinics·John C Marshall, Abdullah al Naqbi
Nov 21, 2009·The European Respiratory Journal·S AlibertiJ A Ramirez
Feb 11, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alan C HeffnerAlan E Jones
Aug 25, 2010·Antimicrobial Agents and Chemotherapy·Mical PaulLeonard Leibovici
Jan 7, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Catherine LiuUNKNOWN Infectious Diseases Society of America
Jan 25, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alison G Freifeld Infectious Diseases Society of America
Jul 30, 2011·Critical Care : the Official Journal of the Critical Care Forum·Gordon P OttoNiels C Riedemann
Sep 17, 2011·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·G ChoudhuryA T Hill
Dec 22, 2011·JAMA : the Journal of the American Medical Association·Jonathan S BoomerRichard S Hotchkiss
May 9, 2012·European Heart Journal·Stuart J HeadA Pieter Kappetein
May 24, 2012·The New England Journal of Medicine·V Marco RanieriUNKNOWN PROWESS-SHOCK Study Group
Feb 14, 2013·JAMA : the Journal of the American Medical Association·Philippe ProkocimerAnita Das
Feb 23, 2013·The Lancet Infectious Diseases·Richard S HotchkissDidier Payen
Feb 28, 2013·Critical Care Medicine·David F GaieskiBrendan G Carr
Mar 21, 2013·JAMA : the Journal of the American Medical Association·Steven M OpalUNKNOWN ACCESS Study Group
Sep 28, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Steven SchmittEric Hammelman
Nov 16, 2013·Nature Reviews. Immunology·Richard S HotchkissDidier Payen
Feb 25, 2014·Clinical Investigation·John H Powers, Thomas R Fleming
Mar 19, 2014·The New England Journal of Medicine·Donald M YealyDerek C Angus
Oct 2, 2014·The New England Journal of Medicine·Sandra L PeakePatricia Williams
Oct 9, 2014·American Journal of Respiratory and Critical Care Medicine·Yahya ShehabiUNKNOWN ANZICS Clinical Trials Group
Mar 18, 2015·The New England Journal of Medicine·Paul R MounceyUNKNOWN ProMISe Trial Investigators
May 21, 2015·The New England Journal of Medicine·Robert G SawyerUNKNOWN STOP-IT Trial Investigators
May 29, 2015·Clinical Microbiology Reviews·Steven Y C TongVance G Fowler

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Citations

Jul 22, 2020·The Journal of Infectious Diseases·Edward J Septimus
Dec 29, 2020·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Eun Jung JungLami Yeo
Aug 5, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Emily J CurrenL Clifford McDonald
Oct 7, 2021·Postgraduate Medical Journal·Abbey KingChris Isles

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