PT - JOURNAL ARTICLE AU - Maged Hassan AU - Mohamed Gad-Allah AU - Basma El-Shaarawy AU - Asmaa M El-Shazly AU - Cyrus Daneshvar AU - Ahmed S Sadaka TI - The Short <em>versus</em> Long antibiotic course for pleural Infection Management (SLIM) randomised controlled open label trial AID - 10.1183/23120541.00635-2022 DP - 2023 Jan 01 TA - ERJ Open Research PG - 00635-2022 4099 - http://openres.ersjournals.com/content/early/2023/02/02/23120541.00635-2022.short 4100 - http://openres.ersjournals.com/content/early/2023/02/02/23120541.00635-2022.full AB - Introduction Based on expert opinion the length of antibiotic treatment for pleural infection in adults is typically recommended to be a minimum of four weeks. This clinical trial aimed to assess whether shorter antibiotic courses lead to more treatment failures than standard longer courses.Methods In an open-label randomised controlled trial adult patients with pleural infection who were medically treated and stabilised within 14 days of admission were randomised to either a short antibiotic course (total course 14–21 days) or a long antibiotic course (total course 28–42 days). Patients were excluded if their baseline RAPID score was &gt;4 (high-risk category). The primary outcome was the incidence of treatment failure by 6 weeks post admission. Secondary outcomes were total length of antibiotic treatment, proportion of patients who resumed normal activity levels within 6 weeks post admission, time from discharge to resuming normal activity levels and the incidence of antibiotic-related adverse reactions.Results Between September 2020 and October 2021 50 patients (35 (70%) males, mean age 46±13.7 years), were recruited to the trial and randomly assigned to the short course group (n=25) or the long course group (n=25) with outcome data available for 24 patients in each study group. Treatment failure occurred in 4 (16.7%) patients in the short course group and 3 (12.5%) patients in the long course group. In the intention-to-treat analysis the odds ratio for treatment failure in the long course group was 0.714 (95% CI 0.142–3.600, p=0.683). The median duration of antibiotic treatment in the short course group was 20.5 [18–22.5] days compared to 34.5 [32–38] days in the long course group (p &lt;0.001). There were no statistically significant differences in the other outcomes.Conclusion In medically treated adult patients with pleural infection a long course of antimicrobial therapy did not lead to less treatment failures in comparison to a shorter course. These findings need to be confirmed in a larger multi-centre trial.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: The authors have nothing to disclose.