Eight Days a Week — Balancing Duration and Efficacy
Abstract
This editorial commentary examines the BALANCE trial, a landmark randomized study evaluating 7 versus 14 days of antibiotic therapy for patients with bacteremia. The author commends the trial’s rigor, large sample size (>3600 patients), exclusion of high-risk infections (e.g., Staphylococcus aureus), and use of 90-day mortality as a robust primary endpoint. Despite physicians occasionally extending therapy beyond 7 days, the shorter duration was noninferior to 14 days. Notably, adverse effects from antibiotics were similar between groups. The commentary underscores the importance of balancing effective infection treatment with antimicrobial stewardship. It also laments the minimal U.S. participation in the trial and calls for revitalized national support for biomedical research infrastructure to tackle antimicrobial resistance and improve global health outcomes.
Keywords:
bloodstream infection
BALANCE trial
antibiotic duration
antimicrobial resistance
clinical trial design
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