How long should we treat Intra-abdominal Infections for? RCT evidence

A recent randomised trial has shown that patients who receive fixed duration antibiotic therapy (approximately 4 days) had similar outcomes to patients who received longer courses (approximately 8 days).

518 patients with complicated intra-abdominal infections were recruited. Patients received either a fixed course of antibiotics or antibiotics until 2 days after the resolution of fever, leucocytosis and ileus to a maximum of 10 days therapy. All patients had undergone a successful source control procedure.

No significant difference was seen in rates of surgical site infection, recurrent abdominal infection or death between the two groups.

This study adds to the body of evidence that sepsis is a sign of the hosts immune activity rather than actively multiplying organisms. Efforts to shorten the duration of antimicrobial therapy in the presence of traditional markers of sepsis have been successful in pneumonia and urinary infection – we will summarise further evidence on treatment durations in another posting.

The paper is available here.

2 comments

  1. Reblogged this on Infectious Diseases and Microbiology postgraduate teaching and commented:
    Highly relevant for all locations- intra-abdominal infection drives much antibiotic therapy in hospitals. The evidence is that scapelmycin (surgery to deal with the source) is the most important treatment and antibiotics play a lesser role. Anaerobic cover is paramount in most circumstances. When peritoneal soiling has been short lived (< 6 hrs) then very short duration (24-48hrs) antibiotic treatment following surgery is safe. This is our current practice in Hunter New England Health, Australia.

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  2. […] perforated appendicitis should be the norm – 4 days once source control achieved (see this posting and […]

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