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Trial of short-course antimicrobial therapy for intraabdominal infection.
- Source :
-
The New England journal of medicine [N Engl J Med] 2015 May 21; Vol. 372 (21), pp. 1996-2005. - Publication Year :
- 2015
-
Abstract
- Background: The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.<br />Methods: We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections.<br />Results: Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, -0.5 percentage point; 95% confidence interval [CI], -7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, -4.0 days; 95% CI, -4.7 to -3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes.<br />Conclusions: In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.).
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Appendicitis drug therapy
Drug Administration Schedule
Female
Fever etiology
Humans
Intraabdominal Infections complications
Intraabdominal Infections mortality
Kaplan-Meier Estimate
Leukocytosis etiology
Male
Medication Adherence
Middle Aged
Peritonitis etiology
Recurrence
Surgical Wound Infection etiology
Young Adult
Anti-Bacterial Agents administration & dosage
Intraabdominal Infections drug therapy
Sepsis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 372
- Issue :
- 21
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 25992746
- Full Text :
- https://doi.org/10.1056/NEJMoa1411162