Antibiotic de-escalation: finally, some action and not only words

• Published in: The Lancet infectious diseases Vol. 24; no. 4; pp. 331 - 333
• Main Authors: Tabah, Alexis, De Bus, Liesbet, Leone, Marc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01-04-2024; Elsevier Limited
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Cefuroxime; Ciprofloxacin; Clinical trials; Ecological studies; Humans; Infections; Low level; Microbial Sensitivity Tests; Multidrug resistant organisms; Retrospective Studies; Sepsis; Sepsis - drug therapy; Statistical analysis
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(23)00749-1

A small embedded ecological study, comparing rectal samples at the onset and end of treatment, provided encouraging, albeit not significant, results in favour of de-escalation. [...]clinical guidelines could suggest de-escalation with only a very low level of evidence, relying mostly on observational data and small randomised controlled trials.5–7 We are confident in the results of the SIMPLIFY trial because they rely on a well conducted statistical analysis exploring endpoints selected by a desirability of outcome ranking analysis, ensuring clinical relevance. A switch from intravenous to oral therapy is an important strategy in terms of sustainability of health care.8 In the control group in the SIMPLIFY study, 118 (71%) of 167 participants were switched to oral antibiotics, using the same molecules that were used for de-escalation in the intervention group (mainly ciprofloxacin and cefuroxime). [...]the SIMPLIFY investigators must be commended for successfully conducting the first large randomised controlled trial that shows safety of de-escalation in a population with Enterobacterales bloodstream infections.