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SYSTEMATIC REVIEW article

Front. Med.

Sec. Intensive Care Medicine and Anesthesiology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1617328

This article is part of the Research TopicInfections in the Intensive Care Unit - Volume IIIView all 22 articles

Antibiotic treatment for 7 days versus 14 days in patients with bloodstream infections:A Systematic review and meta-analysis of randomized controlled trials and trial sequential analysis

Provisionally accepted
Changyun  ZhaoChangyun Zhao1Changqin  ChenChangqin Chen1Difan  LuDifan Lu2Kailun  CaiKailun Cai1Weihang  HuWeihang Hu1Wenchao  MaoWenchao Mao1*
  • 1Zhejiang Hospital, Hangzhou, China
  • 2First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China

The final, formatted version of the article will be published soon.

The optimal duration of antibiotic therapy for bloodstream infections (BSI) remains a topic of ongoing debate. To address this, we conducted a meta-analysis to evaluate the efficacy and safety of 7-day and 14-day antibiotic regimens in the treatment of BSI.We performed a comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library from the inception of these databases up to March 10th, 2025. Randomized controlled trials (RCTs) comparing 7-day and 14-day antibiotic regimens for the treatment of BSI will be included. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. The primary outcomes were all-cause mortality, 90-day mortality, while secondary outcomes included relapsed bacteremia, readmissions or prolongation of hospitalization, suppurative complications, emergence of resistance, length of stay in hospital, and adverse events. Trial sequential analysis (TSA) was then conducted.The meta-analysis included four RCTs involving 4,794 patients. The results indicated no statistically significant differences between the 7-day and 14-day antibiotic regimens in terms of all-cause mortality (RR=0.96, 95% CI: 0.73-1.25, P=0.75) or 90-day mortality (RR=0.94, 95% CI: 0.80-1.10, P=0.45). When the analysis was restricted to BSI caused by Gram-negative bacteria (GNB), no statistically significant differences were observed in all-cause mortality or 90-day mortality. The 7-day antibiotic regimen was associated with a significantly shorter length of stay in hospital compared to the 14-day regimen. However, no significant differences were observed in other secondary outcomes or adverse events, including acute kidney injury (AKI), Clostridioides difficile infection (CDI), diarrhea, and rash. And the TSA suggested that the current findings may have yielded a false negative conclusion.For BSI, the 7-day antibiotic regimen was associated with a significantly shorter length of stay in hospital compared to the 14-day regimen, while demonstrated comparable efficacy and safety outcomes. From this perspective, a 7-day antibiotic regimen seems to be more advisable. However, it is imperative to conduct additional large-scale RCTs to validate and substantiate our findings.

Keywords: bloodstream infections, antibiotics, Treatment duration, Meta-analysis, TSA

Received: 24 Apr 2025; Accepted: 16 Jul 2025.

Copyright: © 2025 Zhao, Chen, Lu, Cai, Hu and Mao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Wenchao Mao, Zhejiang Hospital, Hangzhou, China

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