IV Antibiotic Durations for Nontyphoidal Salmonella Bacteremia

Abstract

OBJECTIVES: The objective was to determine if shorter intravenous (IV) antibiotic (<7 days) for nontyphoidal Salmonella bacteremia (NTS-B) is noninferior to longer (≥7 days) in terms of 30-day emergency department (ER) or rehospitalization in healthy children. METHODS: A retrospective observational study of otherwise healthy children admitted to a children’s hospital in the United States from 2006 to 2017 with NTS-B was conducted. RESULTS: Of 231 patients reviewed, 51 patients had NTS-B. Median IV duration for all patients was 5 days (range 2–17 days). The short-duration group (SDG) (<7 days; N = 32) had a median of 4 days (range 2–6 days) of IV antibiotics versus a median of 9 days (range 7–17 days) in the long-duration group (LDG) (≥7 days; N = 19). The hospital length of stay in the SDG was 3.5 days versus 7 days in the LDG (P < .001). The SDG was significantly noninferior to the LDG in terms of ER visits or hospital readmissions within 30 days (absolute risk difference 5.3%; 95% confidence interval −16% to −5%), with only 1 child in the LDG returning to the ER. CONCLUSIONS: IV antibiotic durations for NTS-B in otherwise healthy children were variable within our study group. Shorter courses (<7 days) of IV antibiotics were noninferior to longer courses in healthy children and reduced hospital stay. ER visits and readmissions were rare, and there was no association between IV treatment duration and risk of relapse. Prospective studies are needed to study the safety of shorter courses, but given the absence of evidence favoring longer courses, shorter courses can be considered.