# P-876. Decision Analysis of Short versus Ultra-Long Course Antibiotics for Complicated Intraabdominal Infection

## TL;DR

This study compares short and ultra-long antibiotic courses for intraabdominal infections using a decision model to determine which strategy offers better outcomes.

## Contribution

The novel contribution is the use of a decision analysis model to compare short versus ultra-long antibiotic courses for complicated intraabdominal infections.

## Key findings

- Short course therapy had a higher overall utility (0.97) compared to ultra-long course therapy (0.92) in base-case analysis.
- Probabilistic sensitivity analysis showed short course therapy was optimal in over 99% of model iterations.
- The model suggests short course therapy may be more effective in terms of utility despite potential recurrence risks.

## Abstract

Short course antibiotic therapy (4 days) following source control for intraabdominal infections has become standard of care. However, recent data suggests that ultra-long course durations (28 days) after source control may drastically reduce recurrence rates. A randomized trial of ultra-long course therapy for complicated intraabdominal infections is currently enrolling. The purpose of this study is to evaluate these two treatment strategies using a decision analysis model.

A decision tree was created from the perspective of a healthcare administrator. The model evaluates the rates of recurrence between these two treatment strategies as well as potential negative impacts of overtreatment and per-day risk of antibiotic-associated adverse events. Model values were taken from the published literature or estimated by the authors. Base-case and probabilistic sensitivity analyses were performed. The model was created using TreeAge Pro Healthcare (TreeAge Software, Inc., Williamstown, MA).

On base-case analysis, short course therapy maximized utility with an overall utility of 0.97 versus 0.92 for ultra-long course therapy. Probabilistic sensitivity analysis, after 100,000 iterations identified short course therapy as the optimal strategy for >99% of model iterations.

In this exploratory model, short course therapy resulted in higher overall utility values compared to ultra-long course treatment. Further work is needed to confirm these findings, including completion of the currently enrolling EXTEND trial.

All Authors: No reported disclosures

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Source: https://tomesphere.com/paper/PMC12792509