Intravenous Therapy Duration and Outcomes in XXXX : A New Treatment Paradigm.

@entity1 @entity6942 @entity326
BACKGROUND: International @entity6942 treatment guidelines recommend a minimum 10 to 14 days' intravenous antibiotic therapy (intensive phase), followed by 3 to 6 months' oral therapy (eradication phase). This approach is associated with rates of relapse, defined as recurrence following the eradication phase, that can exceed 5%. Rates of recrudescence, defined as recurrence during the eradication phase, have not previously been reported. In response to low eradication phase completion rates in Australia, a local guideline has evolved over the last ten years recommending a longer minimum intensive phase duration for many cases of @entity6942 . METHODOLOGY/ PRINCIPAL FINDINGS: This retrospective cohort study reviews antibiotic duration for the first episode of care for all @entity1 diagnosed with @entity6942 and surviving the intensive phase during a recent three year period in the tropical north of Australia's Northern Territory; we also review adherence to the current local guideline and treatment outcomes. Of 215 first episodes of @entity6942 surviving the intensive phase, the median (interquartile range) intensive phase duration was 26 (14-34) days. One hundred and eight (50.2%) @entity1 completed eradication therapy; 58 (27.0%) @entity1 took no eradication therapy. At 28 months' follow-up, one (0.5%) relapse and eleven (5.1%) recrudescences had occurred. On exact logistic regression analysis, the only independent risk factors for recrudescence were self-discharge during the intensive phase (odds ratio 6.2 [95% confidence interval 1.2-30.0]) and @entity326 (odds ratio 5.3 [95% confidence interval 1.1-25.7]). CONCLUSIONS/ SIGNIFICANCE: Relapsed @entity6942 is rare in @entity1 who receive a minimum intensive phase duration specified by our guideline and extended according to clinical progress. Recrudescence rates may improve with reductions in rates of self-discharge. Given the low relapse rate despite a high rate of eradication therapy non-adherence, the duration and necessity of eradication therapy for different @entity1 after guideline-concordant intensive therapy should be evaluated further.
