Brief Antibiotic Course Effective in Gut Infections

A short course of antibiotics for treating abdominal infections yields similar outcomes to standard, longer courses, according to a new study.

Researchers at the University of Virginia Health System (UVHS; Charlottesville, USA), Johns Hopkins University (Baltimore, MD, USA), and other institutions randomly assigned 518 patients from 23 centers with infections and perforations of the small bowel, appendix, colon, and rectum to receive antibiotics until two days after resolution (control group), or to receive a shorter, fixed course of antibiotics (study group). The primary outcome was a composite of surgical-site infection (SSI), recurrent abdominal infection, or death within 30 days; secondary outcomes included the duration of therapy and rates of subsequent infections.

The results showed that primary outcomes in both groups were equivalent, with approximately 20% developing SSI, 40% with recurrent abdominal infections, and 2%–3% of patients dying. The median duration of antibiotic therapy was four days in the study group, as compared with eight days in the control group. The duration of antibiotics did not influence primary outcomes, but 47 patients in the study group received treatment that extended beyond the specified protocol duration; of those, 16 had continued elevated white-cell count and two had persistent fever. The study was published on May 21, 2015, in the New England Journal of Medicine (NEJM).

“Outcomes in patients with intra-abdominal infections who have undergone a successful source-control procedure and receive a fixed, four day course of antimicrobial therapy appear to be generally similar to outcomes in patients in whom systemic antimicrobial agents are administered until after the resolution of signs and symptoms of sepsis,” concluded lead author Robert Sawyer, MD, of the UVHS department of surgery, and colleagues.

Traditionally, physicians have administered antimicrobial therapy to patients with intra-abdominal infections until clinical and laboratory evidence suggests that the infection has resolved, reasoning that ongoing sepsis was indicative of ongoing replication of pathogens. More recent experimental data, however, suggest that a prolonged systemic inflammatory response may be more a reflection of host immune activity than an indication of the presence of viable microorganisms. As such, efforts have begun to shorten the duration of antimicrobial therapy in the presence of traditional markers of sepsis.

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University of Virginia Health System
Johns Hopkins University