Review examines shorter antibiotic courses for sepsis and severe infections in critical care

A review in the American Journal of Respiratory and Critical Care Medicine examines antibiotic treatment duration in critically ill patients with sepsis and severe infections. It integrates mechanistic considerations, pharmacokinetic/pharmacodynamic principles and randomized trial evidence. The abstract does not provide study counts, pooled sample sizes or numerical effect estimates.

The authors report that randomized trials support the noninferiority of short courses, described as fewer than seven days, across selected serious infections, including bacteremia, intra-abdominal infections and ventilator-associated pneumonia. They identify particularly strong support for reduced duration in uncomplicated bloodstream infections after effective source control, intra-abdominal infections and ventilator-associated pneumonia. Procalcitonin-guided algorithms may further individualize treatment duration and reduce antibiotic exposure.

The review emphasizes balancing treatment efficacy against risks of prolonged exposure, including microbiome disruption, superinfection, Clostridioides difficile colitis and resistance. Important uncertainties remain for S. aureus bacteremia, non-fermenting Gram-negative bacilli, difficult-to-treat multidrug-resistant organisms, invasive candidiasis and immunocompromised patients. Retained prosthetic material or devices may require prolonged treatment or long-term suppression. These findings should not be interpreted as a universal duration threshold: infection site, source control, host factors and clinical evolution remain central. Only the abstract was available, limiting assessment of trial-specific regimens and exceptions.