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Principal Investigators
Dr. Nick Daneman
Dr. Rob Fowler

Thanks to all Participating Centers and collaborators for engaging in this research program!

Thanks to the CCCTG for endorsing this research project.
  • CIHR Project Grant
    The BALANCE RCT has been successful in receiving a $2 million CIHR Project Grant for a period of 5 years.
  • INNOVATION AWARD
    The BALANCE Pilot RCT was awarded an Ontario Ministry of Health and Long-Term Care Province wide award for BEST AND MOST INNOVATIVE PROJECT IN THE CATEGORY EVIDENCE- AND PATIENT-CENTRED CARE
  • ANZICS COLLABORATION
    Our partners in New Zealand have submitted the BALANCE grant application to Health Research Council of New Zealand for funding of 10 sites in New Zealand and Australia. 
  • CIHR BRIDGE FUND
    CIHR BRIDGE FUND: BALANCE RCT application was ranked 3/32 among the large RCT applications in 2015. We missed the funding by just one spot. However, CIHR has provided us with $100K as bridge funds to be able to continue with enrollment before the next submission.

The Balance Program

Bloodstream infections are a common and serious problem, affecting 15% of critically ill patients and resulting in a three-fold increased mortality rate. Early treatment with effective antibiotics is essential to improve the outcome of these patients, but the optimal duration of treatment has not been studied. In this void of evidence, excessive durations of antibiotic therapy are contributing to avoidable adverse drug events, Clostridium difficile infection, and increases in antibiotic resistance.


CONTACT US if you are interested in joining this program of research.

The Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) Research Program seeks to define the optimal treatment duration for patients with bloodstream infection.  The goal is to maximize the benefits while minimizing the harms of these treatments, including antibiotic resistance, C. difficile, and other drug-related side effects.

Our Primary Research Question and Hypothesis:

Among critically ill patients with bloodstream infection, is shorter duration antibiotic treatment (7 days) associated with non-inferior mortality rates (at 90 days) to those achieved with longer duration antibiotic treatment (14 days)?  We hypothesize that survival rates will be non-inferior with shorter course treatment.

Our Secondary Hypotheses:

We hypothesize that shorter treatment will also be associated with non-inferior secondary clinical outcomes including: hospital and intensive care unit (ICU) mortality, relapse rates of bacteremia, hospital and ICU length of stay, mechanical ventilation and vasopressor duration.  We hypothesize that shorter course treatment will be associated with more antibiotic-free days in ICU, lower risk of C. difficile infection, lower risk of antibiotic allergy and adverse events, and lower risk of colonization/infection with antibiotic-resistant organisms.