Duration of antibiotic therapy for Enterobacterales and Pseudomonas aeruginosa: a review of recent evidence

Abstract

Purpose of review: Emergence of multidrug-resistant organisms, impact on intestinal microbiome, side effects and hospital costs are some of the factors that have encouraged multiple studies over the past two decades to evaluate different duration of antibiotic therapy with the goal of shorter but effective regimens. Here, we reviewed the most recent relevant data on the duration of therapy focused on two of the most common Gram-negative organisms in clinical practice, Pseudomonas aeruginosa and Enterobacterales.

Recent findings: Recent studies including meta-analysis confirm that short antibiotic courses for both Enterobacterales and P. aeruginosa infections have comparable clinical outcomes to longer courses of therapy. Despite the advocacy for short-course therapy in contemporary guidelines, recent evidence in the USA has revealed a high prevalence of inappropriate antibiotic usage due to excessive duration of therapy.

Summary: Although the decision process regarding the optimal duration of antibiotic therapy is multifactorial, the vast majority of infections other than endocardial or bone and joint, can be treated with short-course antibiotic therapy (i.e., ≤7 days). The combination of biomarkers, clinical response to therapy, and microbiologic clearance help determine the optimal duration in patients with infections caused by P. aeruginosa and Enterobacterales.