Hospital patients who develop infections where 10% of patients die will be offered double the traditional antibiotic treatment in a new trial.
Patients with severe abdominal infections are usually given a two-week treatment, but this is often unsuccessful. Now researchers from the University of Leeds and the University of York are testing a month-long course to see if it’s more effective at clearing the infection.
The EXTEND trial 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 Medical School and NHS Consultant in Microbiology, and M Dermot Burke, Associate Professor of Surgery at Leeds Medical School.
Antimicrobial drug resistance. But these infections are extremely serious and current treatments do not work for a large proportion of patients. We want to see if a longer, fixed course cures more people – if it stops infection from coming back, prevents new infections and saves lives. »
Dr Andrew Kirby, Associate Professor, University of Leeds Medical School
Serious abdominal infections occur when the intestine is damaged, usually by bowel surgery or disease, causing bacteria living in the intestine to leak into the surrounding cavity. These infections are a leading cause of sepsis in intensive care unit patients. Sepsis in the UK kills more people than breast, bowel and prostate cancer combined.
Long courses of antibiotics can be controversial because they can increase the risk of bacteria finding ways to survive the antibiotics, which means that the antibiotics no longer work to fight the infection. Also, there are indications that four days of antibiotics may be enough to treat serious abdominal infections.
The problem with short courses of antibiotics is that 20% of patients do not recover and 10% die from their infection.
Currently, doctors rely on blood tests and patient-reported symptoms to assess whether the infection has cleared. But if the bacteria haven’t been completely eradicated by the antibiotics, they can begin to grow back, leading to a recurrence of the infection and potentially more episodes of sepsis. That’s why researchers now want to determine whether a 28-day course of antibiotics can cure these infections more effectively than a doctor deciding when to stop the course.
Mr Burke said: “Intra-abdominal infections make patients unhappy, tired and keep them in hospital for long periods of time. Improved treatment methods are badly needed.”
Professor Andrew Ustianowski, NIHR Infections Joint National Specialty Leader, said: “Intra-abdominal infections and sepsis are very serious problems in our populations. We have a variety of antibiotics that can help, but we we need specific research to inform us on how best to use them, including for how long.
“This NIHR-funded study is therefore an important trial that I hope will have a direct beneficial impact on our future management of these infections.”
The EXTEND trial is due to begin in August 2022 and will last for three years. He will follow the patients for six months. Half will receive a course of antibiotics prescribed by their doctor, normally for a week or two, and the other half will receive the 28-day course. The trial will be open to hospitalized patients with a serious abdominal infection.