This editorial comments on a post hoc subgroup analysis of immunocompromised patients in the BALANCE trial, which compared 7-day versus 14-day antibiotic courses for uncomplicated bloodstream infections in patients with mild-to-moderate immunosuppression.
No differences in 90-day all-cause mortality or secondary clinical outcomes were found between 7-day and 14-day antibiotic courses in immunocompromised patients with mild-to-moderate immunosuppression, supporting shorter treatment durations in this group.
The subgroup analysis was post hoc and neither designed nor powered to confirm the trial's mortality hypothesis in immunocompromised patients; most high-risk groups (e.g., neutropenic patients, transplant recipients) were excluded from the original BALANCE trial by protocol.
For immunocompromised patients with mild-to-moderate immunosuppression and uncomplicated bloodstream infections, a 7-day antibiotic course appears non-inferior to 14 days and may be a reasonable standard. Clinicians should note this does not yet apply to high-risk groups such as neutropenic patients or transplant recipients.
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