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Effect of C-Reactive Protein–Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients With Uncomplicated Gram-Negative Bacteremia

Effect of C-Reactive Protein–Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day... Key PointsQuestionDoes antibiotic treatment with C-reactive protein (CRP)–guided duration or fixed 7-day duration, compared with fixed 14-day duration, provide noninferior clinical failure rates in patients with uncomplicated gram-negative bacteremia? FindingsIn this randomized clinical trial that included 504 adults with uncomplicated gram-negative bacteremia, 30-day clinical failure occurred in 2.4% of patients assigned to receive CRP-guided antibiotic treatment duration, 6.6% assigned to 7-day treatment, and 5.5% assigned to 14-day treatment. The differences between CRP-guided treatment and 7-day treatment compared with 14-day treatment met the noninferiority criterion of 10%, but adherence to the CRP strategy or planned follow-up did not occur in 23% of patients. MeaningCRP-guided treatment and 7-day treatment were noninferior to 14-day treatment in patients with uncomplicated gram-negative bacteremia, but interpretation is limited by the large noninferiority margin compared with the low observed event rate and lower adherence in the CRP-guided group. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Effect of C-Reactive Protein–Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients With Uncomplicated Gram-Negative Bacteremia

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Publisher
American Medical Association
Copyright
Copyright 2020 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2020.6348
Publisher site
See Article on Publisher Site

Abstract

Key PointsQuestionDoes antibiotic treatment with C-reactive protein (CRP)–guided duration or fixed 7-day duration, compared with fixed 14-day duration, provide noninferior clinical failure rates in patients with uncomplicated gram-negative bacteremia? FindingsIn this randomized clinical trial that included 504 adults with uncomplicated gram-negative bacteremia, 30-day clinical failure occurred in 2.4% of patients assigned to receive CRP-guided antibiotic treatment duration, 6.6% assigned to 7-day treatment, and 5.5% assigned to 14-day treatment. The differences between CRP-guided treatment and 7-day treatment compared with 14-day treatment met the noninferiority criterion of 10%, but adherence to the CRP strategy or planned follow-up did not occur in 23% of patients. MeaningCRP-guided treatment and 7-day treatment were noninferior to 14-day treatment in patients with uncomplicated gram-negative bacteremia, but interpretation is limited by the large noninferiority margin compared with the low observed event rate and lower adherence in the CRP-guided group.

Journal

JAMAAmerican Medical Association

Published: Jun 2, 2020

References