Optimal duration of the antimicrobial treatment of ventilator-acquired pneumonia

Abstract

The optimal duration of antimicrobial treatment of patients with ventilator-associated pneumonia is a major concern for clinicians. We looked for the evidence that a short course of therapy (< or =10 days) is as effective as a traditional long-course therapy (14-21 days). Unfortunately, only one trial (PneumA trial) has focused directly on this question. To further evaluate this issue, we identified trials in which the duration of anti-infective treatment was used as the outcome. Such trials, by providing data on mortality, length of intensive care unit stay and recurrence, may allow for estimating the association between duration of therapy and the aforementioned outcomes. Nine such trials were identified; all reported a decrease in the total length of antibiotic administration (statistically significant in seven) with the application of the intervention studied. Short, as opposed to long, courses of antibiotics did not adversely affect mortality, length of intensive care unit stay or recurrence rates. In conclusion, the available evidence seems to support the use of short-course antimicrobial treatments (< or =10 days) for patients with ventilator-acquired pneumonia not caused by nonfermenting Gram-negative bacilli.