Short-course therapy for bloodstream infections in immunocompetent adults

Short courses of antibiotic therapy have many advantages. However, determining which patients may safely receive abbreviated therapy can be challenging. In this review we present data for bloodstream infections caused by various organisms, linking outcomes to factors such as the duration of symptoms and bacteraemia before and after initiation of treatment, community vs. hospital acquisition of infection, evidence of foci of tissue infection, presence of foreign material, immune status and response to antibiotics. These data support the following recommendations for the minimum duration of antibiotic treatment for carefully selected low-risk patients with bloodstream infections: Staphylococcus aureus, 14 days; coagulase-negative staphylococci, 3–5 days; enterococci, 7 days; viridans-group streptococci, 3–5 days and Candida spp., 7 days. Patients with bloodstream infections treated with short-course therapy must be followed carefully for occult complications, and should ideally be under the care of an infectious diseases physician.