Patient Case: Gram-negative Bacteremia Duration of Treatment

A 40 year old with no relevant PMH is hospitalized with pyelonephritis and cultures positive for Klebsiella pneumoniae. She has received 3 days of ceftriaxone and is now ready for dischargeWhat is the best TOTAL length of therapy?

A) 7 Days
B) 14 Days
C) I’m just here for the answer

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Best Answer

7 Days

Explanation: Multiple randomized controlled trials have demonstrated similar mortality & readmissions in uncomplicated gram-negative bacteremia in patients treated with 7 vs 14 days of active antibiotics. What makes this case uncomplicated? This patient: 1) has a urinary source 2) no need for source control 3) is NOT immunocompromised 4) clinically improved within 72 hours

Remember one of our favorite antimicrobial stewardship mantras: Shorter is Better!

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