What is there to say about a study that compares the treatment of an infection with X versus Y days of antibiotics? The recently published STOP-IT trial didn't reveal groundbreaking new approaches to treatment or prevention, or provide keen insights into pathogenesis or transmission. The investigators simply compared 2 antibiotic treatment durations for abdominal sepsis: a short course after source control (about 4 days), versus a more standard course that continued until fever, elevated white cell count and ileus had resolved for 2 days or so (to a maximum of 10 days). The verdict? No difference in outcomes (a composite of surgical site infection, recurrent intra-abdominal infection, or death within 30 days). Our own Mike Edmond and Dick Wenzel penned the excellent accompanying editorial, to which I refer you for more detailed commentary.
I like this study, and we clearly need more studies that test our current approaches to antimicrobial treatment of common infections. “How long do we need to treat this infection?” is 1 of the most frequent questions we get as infectious disease consultants, and it's amazing how scant the evidence base is regarding duration of therapy. Studies like this one, and this oft-cited study that helped reduce our duration of treatment for ventilator-associated pneumonia, have the potential to markedly reduce unnecessary antimicrobial therapy, thereby reducing risk for Clostridium difficile and antimicrobial resistance emergence, among other adverse effects of antimicrobial overuse.
Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.