The following is a summary of the “Shorter antibiotic courses in the immunocompromised: the impossible dream?,” published in the February 2023 issue of Clinical microbiology and Infectious Disease by Imlay, et al.

Shorter regimens of antibiotic treatment for bacterial infections have shown similar outcomes in a rising number of trials. Despite the potential advantages of reducing antibiotic duration in immunocompromised patients, they are often left out of these research trials (including lower risks of antibiotic toxicity, Clostridioides difficile infection, drug-resistant pathogens, and microbiome alterations). The purpose of this study was to conduct a comprehensive literature review on the effects of shorter antibiotic courses in immunocompromised patients, focusing on those who had received a solid organ transplant and those who had experienced neutropenic fever (NF) syndromes as a result of anticancer chemotherapy or a hematopoietic cell transplant.

Databases such as MEDLINE, EMBASE, and PUBMED, as well as publications detailing clinical practice standards, were scoured for relevant references. Most research evaluating the effects of shorter antibiotic courses among organ transplant patients has been conducted retrospectively, and it has found equal rates of clinically relevant endpoints regardless of treatment duration. Both high- and low-risk NF patients have been extensively investigated, with some even being enrolled in randomized trials; nevertheless, these studies have included widely different patient populations and outcome measures. 

Fewer antibiotic days were used, but there was no difference in the rates of fever recurrence or mortality when shorter courses were adopted as part of a strategy for clinical improvement. Shorter courses of antibiotic treatment for immunocompromised hosts with suspected bacterial infections should be evaluated in light of research proving efficacy in immunocompetent patients. Patients with NF syndromes and those who have received an organ transplant should be given top priority in randomized controlled clinical trials investigating shorter course therapy.

Source: sciencedirect.com/science/article/abs/pii/S1198743X22004232