Abdominal pain

Study to trial extra antibiotics treating abdominal infections launches

NHS patients who develop lethal abdominal infections will now be offered double the traditional dose of antibiotics in a new trial funded by the National Institute for Health and Care Research (NIHR).

Patients with deadly abdominal infections are usually given a two-week course, with this often proving unsuccessful, but now, NIHR-funded researchers at the University of York and the University of Leeds are investigating whether a month-long course of antibiotics is effective in dealing with the infection.

The EXTEND trial is being co-led by Dr Andrew Kirby, an Associate Professor at the University of Leeds’ School of Medicine and an NHS Consultant in Microbiology, and Dermot Burke, an Associate Professor in Surgery also at the University of Leeds’ School of Medicine.

Dr Andrew Kirby said: “There can be aversion to prescribing longer courses of antibiotics due to the risk of antimicrobial resistance to the drugs. But these infections are extremely serious and the current treatments do not work for a large proportion of patients. We want to see if a longer, fixed course cures more people - whether it stops the infection coming back, prevents new infections, and saves lives.”

These types of infections occur when the intestine is damaged, often as a result of bowel surgery or disease, causing bacteria living in the intestine to leak into the surrounding cavity – abdominal infections are a leading cause of sepsis in patients in intensive care units, which kills more people in the UK than breast, bowel, and prostate cancer combined.

Longer courses of antibiotics can be contentious as it may increase the risk of the bacteria finding a way to survive the treatment, meaning the antibiotics are no longer a viable tool in fighting the infection.

The issue with shorter courses of antibiotics is that 20% of patients are not cured by the end and 10% of patients die following their infection, although there is guidance indicating that four days of antibiotics may be enough to treat serious abdominal infections.

Doctors currently rely on blood tests and patient-reported symptoms to decipher whether the infection has cleared up, but if the bacteria has not been fully eradicated by the antibiotic treatment, they can start regrowing, leading to a recurrence in the infection and possibly more cases of sepsis.

This is why researchers now want to trial a set 28-day period of antibiotics, to ascertain whether it can cure these infections more effectively than the traditional two-week course, or just letting a doctor decide when to stop the course.

Professor Andrew Ustianowski, NIHR Joint National Infection Specialty Lead, said: "Intra-abdominal infections and sepsis are very serious issues in our populations. We have a variety of antibiotics that can help but 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 expect will have a direct beneficial impact on our future management of these infections."

The trial will start this month and will run for three years, following patients for six months – half will receive a course of antibiotics prescribed by their doctor, usually a week or two, whilst the other half will receive a 28-day course.

More information about the study is available here.

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