Methodology: 1/5          
Usefulness: 1/5

von Dach E, et al. JAMA. 2020 Jun 2;323(21):2160-2169. doi: 10.1001/jama.2020.6348.

Question and Methods: In a multi-center, noninferiority, randomized, double-blinded clinical trial, the authors compared the rates of clinical failure by day 30 on individualized CRP-guided antibiotic durations compared to a fixed 7-day regimen vs a fixed 14-day regimen in patients with GNB.
Findings: 30-day clinical failure rates in the CRP-guided and the 7-day treatment group were non-inferior to the 14-day treatment group (2,4%, 6.6% and 5.5% respectively).  
Limitations: There was a significant loss of patients to follow-up, many patients in each group did not undergo ITT analysis due to deviations from the study protocol, and this was a large European Caucasian population. 

Interpretation: CRP should not be used in the ED to guide antibiotic treatment duration in GNB.

By: Dr. Darren Wong

Authors

  • Dr. Darren Wong is a FRCPC Emergency Medicine Resident who has an interest in the care of critically ill patients. He is currently completing additional sub-speciality training in trauma and resuscitation in Toronto.

  • Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.