Historical collection · First published Nov 20, 2024; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections
BALANCE Investigators, for the Canadian Critical Care Trials Group, the Association of Medical Microbiology and Infectious Disease Canada Clinical Research Network, the Australian and New Zealand Intensive Care Society Clinical Trials Group, and the Australasian Society for Infectious Diseases Clinical Research Network, Nick Daneman, Asgar Rishu, Ruxandra Pinto, Benjamin A Rogers, Yahya Shehabi, Rachael Parke, Deborah Cook, Yaseen Arabi, John Muscedere, Steven Reynolds, Richard Hall, Dhiraj B Dwivedi, Colin McArthur, Shay McGuinness, Dafna Yahav, Bryan Coburn, Anna Geagea, Pavani Das, Phillip Shin, Michael Detsky, Andrew Morris, Michael Fralick, Jeff E Powis, Christopher Kandel, Wendy Sligl, Sean M Bagshaw, Nishma Singhal, Emilie Belley-Cote, Richard Whitlock, Kosar Khwaja, Susan Morpeth, Alex Kazemi, Anthony Williams, Derek R MacFadden, Lauralyn McIntyre, Jennifer Tsang, Francois Lamontagne, Alex Carignan, John Marshall, Jan O Friedrich, Robert Cirone, Mark Downing, Christopher Graham, Joshua Davis, Erick Duan, John Neary, Gerald Evans, Basem Alraddadi, Sameera Al Johani, Claudio Martin, Sameer Elsayed, Ian Ball, Francois Lauzier, Alexis Turgeon, Henry T Stelfox, John Conly, Emily G McDonald, Todd C Lee, Richard Sullivan, Jennifer Grant, Ilya Kagan, Paul Young, Cassie Lawrence, Kevin O'Callaghan, Matthew Eustace, Keat Choong, Pierre Aslanian, Ulrike Buehner, Tom Havey, Alexandra Binnie, Josef Prazak, Brenda Reeve, Edward Litton, Sylvain Lother, Anand Kumar, Ryan Zarychanski, Tomer Hoffman, David Paterson, Peter Daley, Robert J Commons, Emmanuel Charbonney, Jean-Francois Naud, Sally Roberts, Ravindranath Tiruvoipati, Sachin Gupta, Gordon Wood, Omar Shum, Spiros Miyakis, Peter Dodek, Clement Kwok, Robert A Fowler, The BALANCE Investigators, for the Canadian Critical Care Trials Group, the Association of Medical Microbiology and Infectious Disease Canada Clinical Research Network, the Australian and New Zealand Intensive Care Society Clinical Trials Group, and the Australasian Society for Infectious Diseases Clinical Research NetworkBALANCE Investigators, for the Canadian Critical Care Trials Group, the Association of Medical Microbiology and Infectious Disease Canada Clinical Research Network, the Australian and New Zealand Intensive Care Society Clinical Trials Group, and the Australasian Society for Infectious Diseases Clinical Research Network, Nick Daneman, Asgar Rishu et al.
First online Nov 20, 2024On EM Weekly Oct 27, 2026Discovered Oct 27, 2026AI-generated Not yet human-reviewed
BALANCE randomized 3,608 hospitalized patients with bloodstream infection to 7 or 14 days of antibiotics. Ninety-day mortality was 14.5% versus 16.1% (difference −1.6 percentage points; 95.7% CI −4.0 to 0.8), meeting the prespecified 4-point noninferiority margin. More than half were in an ICU at enrollment.
Why it matters
Supports avoiding an automatic 14-day course for eligible bacteremia once the pathogen, source and clinical course are established. It does not justify shorter treatment for excluded infections.
Study at a glance
Design
Randomized trial
Population
Hospitalized adults with bloodstream infection at 74 hospitals in seven countries.
Sample size
3608
Intervention
Seven days of antibiotics; agent, dose and route selected clinically.
Comparator
Fourteen days of antibiotics.
Primary endpoint
All-cause mortality by 90 days after bloodstream infection diagnosis.
Main findings
Mortality: 261 patients (14.5%) versus 286 (16.1%).
Per-protocol risk difference: −2.0 percentage points (95% CI −4.5 to 0.6).
Limitations
Severe immunosuppression, S aureus bacteremia and foci requiring prolonged therapy were excluded. Treatment exceeded assignment in 23.1% of the 7-day group; noninferiority is not proof that all durations are equivalent.
Read the primary source
Full text: Abstract available; full text paywalled.
Source retrieved Oct 27, 2026. Historical backfill: first-online date verified from the PubMed electronic publication record. Abstract reviewed; full text unavailable. This is historical evidence, not a new 2026 publication.