When treating infections, the most critical actions are to quash the infection at its site of origin and prevent it from spreading. If allowed to spread to the bloodstream, an infection could result in body-wide inflammation known as sepsis that can cause organ failure and death.
Intra-abdominal infections, most often caused by gut bacteria, can lead to painful inflammation and present a high risk for sepsis. These infections, which include appendicitis, are some of the most common illnesses around the world.
A standard treatment regimen includes surgically removing the original infection and then prescribing antibiotics to keep the infection from coming back and to prevent sepsis. Currently, doctors administer antibiotics until 2 days after the symptoms disappear, for a total of up to 2 weeks.
Like many other researchers, University of Virginia’s Robert Sawyer 
wondered if treating intra-abdominal infections with shorter antibiotic courses could be just as effective as the standard treatment. To find out, he and a team of researchers from around the country designed the Study to Optimize Peritoneal Infection Therapy (STOP-IT).
The study involved about 500 patients at 23 centers who had a procedure to remove the intra-abdominal infection and were then treated with antibiotics either for 4 days or for the standard duration.
The results, published in The New England Journal of Medicine on May 21, suggest that patients given a 4-day course of antibiotics had similar outcomes in terms of recurrent infection and death as patients given the longer symptoms-based course.
Doctors have already seen that reducing the length of antibiotic treatment can work. For example, one study from 2003 indicated that giving people with pneumonia an 8-day antibiotic regimen was as effective as a 15-day regimen.
According to an editorial that accompanied the recent research paper, a 4-day drug regimen to treat abdominal infections could save the United States $97 million annually and decrease the risk of antibiotic resistance as well as the incidence of drug-related side effects.
“The STOP-IT trial essentially cut in half the length of antibiotic treatment, meaning fewer side effects for patients and dramatically lower costs,” said Sarah Dunsmore, one of NIGMS’ experts on sepsis, in a University of Virginia news release about the study. She adds, “STOP-IT findings also have important implications for sepsis treatment where antibiotics are part of the standard treatment protocol.”
This work was funded in part by NIH grants R01GM081510 and AI078875.