Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE): A Pilot Randomized Controlled Clinical Trial


Nicholas Daneman
Sunnybrook Health Sciences Centre

Project Information

The BALANCE RCT will define a treatment duration paradigm for patients with bacteremia. If shorter course treatment (7 days) is non-inferior to longer course (14 days) this intervention will be simple to implement (no new technology) and sustainable (cheaper than existing standard of care). This will lead to more than 100,000 fewer days of antibiotic treatment, and more than $10 million in savings per year in Ontario drug acquisition costs alone. Downstream benefits will include reductions of C. difficile infections, antibiotic resistant pathogens, drug adverse events, and ICU/hospital lengths of stay. For future study, we are seeking larger scale funding for the main BALANCE trial of 7 versus 14 days treatment for bacteremia. This trial will require 3598 patients, across 38 Canadian ICUs, to test whether 7 day treatment is associated with a non-inferior 90 day mortality rate. Although this trial will cost $4 million, this will be offset quickly by drug acquisition cost-savings (estimated to be >$10 million/ year in Ontario alone), as well as much larger cost-savings related to reductions in C. difficile, antibiotic resistant pathogens, drug adverse events, ICU and hospital lengths of stay, and home care administration of antibiotic treatments.

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