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

Added March 22, 2020

Citation: Pugh R, Grant C, Cooke RPD, et al. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database of Systematic Reviews 2015; (8): CD007577

What is this? Some patients with COVID-19 will become critically ill and need to be treated in an intensive care unit (ICU). Pneumonia is the most common hospital-acquired infection, particularly affecting patients in the ICU. Antibiotic courses of different lengths are used to treat it.

In this Cochrane systematic review, the authors searched for randomized trials comparing a ‘short’ duration of antibiotic therapy versus a ‘prolonged’ course for hospital-acquired pneumonia in critically ill adults, including those on mechanical ventilation who might develop ventilator-acquired pneumonia (VAP). They did not restrict by date or language of publication and did their searches in June 2015. They identified 6 eligible studies (1088 participants), but with substantial variation in how the included patients’ pneumonia was diagnosed or defined.

What works: For patients with VAP, courses of antibiotics lasting 7 or 8 days increase the number of antibiotic‐free days in the 4 weeks after treatment and reduce the recurrence of pneumonia compared with courses lasting 10 to 15 days, without increasing mortality or other recurrence outcomes.

What doesn’t work: For patients with VAP specifically due to non‐fermenting Gram‐negative bacilli (NF‐GNB), recurrence was greater after 8-day courses compared to courses lasting 10 to 15 days, but mortality outcomes were not significantly different.

What’s uncertain: Nothing noted.


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