Hospital patients who develop infections in which 10% of the patients die will be offered double the traditional course of antibiotics in a new trial.
Patients with severe abdominal infections usually receive a two-week course, but this is often unsuccessful. Now researchers from the University of Leeds and the University of York are testing a month-long course to determine if it is more effective at clearing the infection.
The EXTEND study is funded by the National Institute for Health and Care Research (NIHR) and co-led by Dr. Andrew Kirby, Associate Professor at the University of Leeds’ School of Medicine and an NHS Consultant in Microbiology, and Mr Dermot Burke, Associate Professor of Surgery at Leeds Medical School.
Antimicrobial resistance to the drugs. But these infections are very serious and current treatments do not work for a large proportion of patients. We want to see if a longer, steady course cures more people — whether it stops the infection, prevents new infections and saves lives.”
dr. Andrew Kirby, Associate Professor, University of Leeds Medical School
Serious abdominal infections occur when the gut is damaged, usually from bowel surgery or disease, which causes bacteria living in the gut to leak into the surrounding cavity. These infections are a leading cause of sepsis in patients in intensive care units. Sepsis in the UK kills more people than breast, colon and prostate cancers combined.
Long courses of antibiotics can be controversial because they can increase the risk that bacteria will find ways to survive the antibiotics, meaning the antibiotics no longer work to fight the infection. There is also some evidence that four days of antibiotics may be enough to treat severe abdominal infections.
The problem with short courses of antibiotics is that 20% of patients do not recover and 10% die after their infection.
Currently, doctors rely on blood tests and patient-reported symptoms to assess whether the infection has cleared. But if the bacteria are not completely eradicated by the antibiotics, they can start growing again, resulting in a recurrence of the infection and possibly more episodes of sepsis. That’s why researchers now want to determine whether a fixed 28-day course of antibiotics can cure these infections more effectively than a doctor who decides when to stop the course.
Burke said: “Intra-abdominal infections make patients miserable and fatigued and keep people in the hospital for a long time. Improved treatment methods are desperately needed.”
Professor Andrew Ustianowski, NIHR Joint National Infection Specialty Lead, said: “Intra-abdominal infections and sepsis are very serious problems in our populations. We have a variety of antibiotics that can help, but we need specific research to inform us about the best way to them, also for how long.
“This NIHR-funded study is therefore an important study that I expect will have a direct beneficial effect on our future management of these infections.”
The EXTEND trial will start in August 2022 and will last for three years. It will follow the patients for six months. Half are prescribed a course of antibiotics by their doctor, normally for a week or two, and the other half are given the 28-day course. The trial is open to patients in hospital with a serious abdominal infection.