Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults

Abstract

We conclude that for patients with VAP not due to NF-GNB, a short fixed-course (seven or eight days) antibiotic therapy may be more appropriate than a prolonged course (10 to 15 days). Use of an individualised strategy (incorporating clinical features or serum procalcitonin) appears to safely reduce duration of antibiotic therapy for VAP.

Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta‐Analysis

“…Pediatric studies have demonstrated the success of shorter antibiotic courses in both outpatient 49 and inpatient populations 50 . Prior meta‐analyses have shown noninferiority of shorter antibiotic courses in adults with VAP 15,16 ; in neonatal, pediatric, and adult patients with bacteremia 17 ; and in pediatric and adult patients with pneumonia and UTI 3‐6,18,19 . Our meta‐analysis extends the evidence for the safety of shorter treatment courses to adults hospitalized with common infections, including pneumonia, UTI, and intra‐abdominal infections.…”

Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta‐Analysis

“…Pediatric studies have demonstrated the success of shorter antibiotic courses in both outpatient 49 and inpatient populations 50 . Prior meta‐analyses have shown noninferiority of shorter antibiotic courses in adults with VAP 15,16 ; in neonatal, pediatric, and adult patients with bacteremia 17 ; and in pediatric and adult patients with pneumonia and UTI 3‐6,18,19 . Our meta‐analysis extends the evidence for the safety of shorter treatment courses to adults hospitalized with common infections, including pneumonia, UTI, and intra‐abdominal infections.…”

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

“…Shorter treatment duration was associated with emergence of fewer multidrug-resistant pathogens (−20 %) [ 101 , 102 ]. These findings and the results of other similar studies have had a decisive influence on the assessment and conclusions reached in recent meta-analyses [ 222 , 223 ]. Other good scientific studies on urinary tract infection show similar results [ 224 ].…”

Role of Appropriate Therapy in Combating Mortality among the Ventilated Patients

“…The duration of antibiotics can also alter the course of treatment. A short course of seven days therapy is associated with reduction in multidrug resistant pathogen and the duration of antibiotics except for nonfermenting Gram negative bacilli [13]. In our study the mortality rate in VAP patients receiving inappropriate therapy was 80%, while in those receiving appropriate therapy the mortality rate was 38.5% respectively.…”

Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta‐Analysis

“…Pediatric studies have demonstrated the success of shorter antibiotic courses in both outpatient 49 and inpatient populations 50 . Prior meta‐analyses have shown noninferiority of shorter antibiotic courses in adults with VAP 15,16 ; in neonatal, pediatric, and adult patients with bacteremia 17 ; and in pediatric and adult patients with pneumonia and UTI 3‐6,18,19 . Our meta‐analysis extends the evidence for the safety of shorter treatment courses to adults hospitalized with common infections, including pneumonia, UTI, and intra‐abdominal infections.…”

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

“…Shorter treatment duration was associated with emergence of fewer multidrug-resistant pathogens (−20 %) [ 101 , 102 ]. These findings and the results of other similar studies have had a decisive influence on the assessment and conclusions reached in recent meta-analyses [ 222 , 223 ]. Other good scientific studies on urinary tract infection show similar results [ 224 ].…”

Role of Appropriate Therapy in Combating Mortality among the Ventilated Patients

“…The duration of antibiotics can also alter the course of treatment. A short course of seven days therapy is associated with reduction in multidrug resistant pathogen and the duration of antibiotics except for nonfermenting Gram negative bacilli [13]. In our study the mortality rate in VAP patients receiving inappropriate therapy was 80%, while in those receiving appropriate therapy the mortality rate was 38.5% respectively.…”

Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta‐Analysis

“…Pediatric studies have demonstrated the success of shorter antibiotic courses in both outpatient 49 and inpatient populations 50 . Prior meta‐analyses have shown noninferiority of shorter antibiotic courses in adults with VAP 15,16 ; in neonatal, pediatric, and adult patients with bacteremia 17 ; and in pediatric and adult patients with pneumonia and UTI 3‐6,18,19 . Our meta‐analysis extends the evidence for the safety of shorter treatment courses to adults hospitalized with common infections, including pneumonia, UTI, and intra‐abdominal infections.…”

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

“…Shorter treatment duration was associated with emergence of fewer multidrug-resistant pathogens (−20 %) [ 101 , 102 ]. These findings and the results of other similar studies have had a decisive influence on the assessment and conclusions reached in recent meta-analyses [ 222 , 223 ]. Other good scientific studies on urinary tract infection show similar results [ 224 ].…”

Role of Appropriate Therapy in Combating Mortality among the Ventilated Patients

“…The duration of antibiotics can also alter the course of treatment. A short course of seven days therapy is associated with reduction in multidrug resistant pathogen and the duration of antibiotics except for nonfermenting Gram negative bacilli [13]. In our study the mortality rate in VAP patients receiving inappropriate therapy was 80%, while in those receiving appropriate therapy the mortality rate was 38.5% respectively.…”