7 Days Noninferior in Bacteremia
BALANCE compared 7 vs 14 days of treatment among hospitalized patients with bloodstream infections.
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By
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Kathryn Wighton
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May 12, 2026
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Objective:
To evaluate the noninferiority of 7 days versus 14 days of adequate antibiotic treatment in hospitalized patients with bloodstream infections.
Key Findings:
- 15% mortality in the 7-day group vs. 16% in the 14-day group by 90 days.
- Per-protocol analysis showed 13% mortality in the 7-day group vs. 15% in the 14-day group.
- Patients assigned to 7 days had a median of 19 antibiotic-free days by day 28.
Interpretation:
The study supports shorter antibiotic courses in critically ill populations without compromising patient outcomes.
Limitations:
- Open-label design and protocol nonadherence with 23.1% of 7-day and 10.7% of 14-day patients receiving longer treatment.
- Underpowered to determine benefits of longer treatment in selected patient populations.
- Exclusions of certain infections and conditions limit generalizability.
Conclusion:
Shorter antibiotic treatment durations can be effective, supporting antibiotic stewardship efforts and reducing drug exposure and costs.
