A SYSTEMATIC review and meta-analysis suggest that a 7-day course of antibiotics is as effective as a 14-day regimen for most patients with Gram-negative bloodstream infections.
Researchers conducted a comprehensive analysis of four randomised clinical trials, including 3,729 hospitalised adult patients diagnosed with Gram-negative bloodstream infections. The study followed PRISMA guidelines, with two independent investigators selecting trials and extracting data. The Cochrane Risk of Bias Tool, version 2, was used to assess study quality, and a Grading of Recommendations Assessment was applied to determine evidence certainty. Data from intention-to-treat (ITT) and per-protocol (PP) populations were pooled using random-effects meta-analysis, with risk ratios and 95% credible intervals calculated.
In the ITT analysis, 12.8% of patients receiving 7 days of antibiotics died within 90 days, compared to 13.7% in the 14-day group. This resulted in a risk ratio of 0.91 (95% credible interval [CrI]: 0.69-1.22) and a 97.8% probability of noninferiority. The PP analysis produced similar results, with a risk ratio of 0.93 (95% CrI: 0.68-1.32) and a 95.1% probability of noninferiority. These findings indicate that a shorter course of antibiotics does not increase mortality risk.
The results support the use of a 7-day antibiotic regimen for most Gram-negative bloodstream infections, provided there are no concerns about inadequate source control.
Reference
Lee TC et al. Seven vs fourteen days of antibiotics for gram-negative bloodstream infection: a systematic review and noninferiority meta-analysis. JAMA Netw Open. 2025;8(3):e251421.
