Short-course antibiotic therapy shows comparable outcomes to extended courses in ICU patients with MDR Gram-negative infections

This meta-analysis pooled data from randomized controlled trials involving 602 critically ill patients in intensive care units with multidrug-resistant Gram-negative bacterial infections. The analysis compared short-course antibiotic therapy (7 days in OPTIMISE; individualized 6-7 days in REGARD-VAP) against extended antibiotic therapy (14 days in OPTIMISE; 8-9 days in REGARD-VAP). The primary outcomes included a composite of mortality and reinfection/recurrence, as well as these outcomes individually.

For mortality, there was no significant difference between treatment groups (OR 0.74, 95% CI 0.45-1.23). Clinical failure also showed no significant difference (OR 0.82, 95% CI 0.50-1.36). Relapse occurred more often with short-course therapy (OR 2.04, 95% CI 0.85-4.92), but this finding was not statistically significant.

Safety and tolerability data were not reported in the meta-analysis. Key limitations were not reported, including potential heterogeneity between the included trials, follow-up duration, and specific patient characteristics. The funding sources and conflicts of interest were also not reported.

For practice, shorter antibiotic regimens appear comparable to extended courses for critically ill patients with these infections, based on the available evidence. However, the non-significant trend toward increased relapse with shorter therapy suggests clinicians should remain vigilant. These findings support cautious consideration of antibiotic duration reduction in this population, but individual patient factors and local resistance patterns should guide decisions.