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Core IM | Internal Medicine Podcast

#195 Antibiotic Duration & BALANCE Trial: Beyond Journal Club with NEJM Group

Core IM | Internal Medicine Podcast

Core IM Team

Education, Mental Health, Health & Fitness, Medicine

4.81K Ratings

🗓️ 10 December 2025

⏱️ 25 minutes

🧾️ Download transcript

Summary

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In this episode, we walk through the BALANCE trial and use it as a lens to revisit how 1) host, 2) organism, and 3) source should guide treatment. When shorter really is enough, and when it isn’t?

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🔹 Transcript and Shownotes

Timestamp

(02:58) | Host, Organism, Source: The Core Framework Behind Duration

(09:02) | How Evidence Shifted Practice

(11:27) | The BALANCE Trial: Short-Course vs Standard-Course Therapy

(18:55) | Where does this leave us?


Tags: CoreIM, Internal Medicine, Infectious disease, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education



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Transcript

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1:07.7

One thing that I liked that someone said to me once was it's not always right to follow the guidelines, but if you're not following the guidelines, you want to be able to articulate why you're not following the guidelines. Welcome to Beyond Journal Club, a collaboration between Core I.M and NEJM group. The goal of Beyond Journal Club is to take landmark clinical trials and put them into context, telling the story of how we got to where we were and what it means to take care of our patients. I'm Dr. Schrodeh Chubetti and internist at Beth Israeliq and Medical Center. I'm Dr. Greg Katz, cardiologist at NYU. And I'm Dr. Clemley, a Medpiz hospitalist in Boston and a guest editor at NEJM. And I'm Dr. Manaling Nigam, an editorial fellow at New England Journal of Medicine and a neurologist at Mass General Brigham.

1:48.0

And today, we're looking at antibiotic duration with the help of the balanced trial published in the Newland Journal of Medicine in 2025.

1:55.3

And I know this has been a question that's made me pause. When can my patient come off antibiotics?

1:59.8

Or patients also want to know about

2:01.5

and on top of that there are so many people reading our notes, case managers, you name it,

2:05.8

who are asking on the rounds, hey, does this person need a pick line? When can they go home?

2:09.6

How long do they really need antibiotics for?

2:12.6

And while this question may seem straightforward at first glance, they think it's a much more

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