PMID- 21975771
OWN - NLM
STAT- MEDLINE
DCOM- 20111102
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 10
DP  - 2011 Oct 5
TI  - Short-course versus prolonged-course antibiotic therapy for hospital-acquired 
      pneumonia in critically ill adults.
PG  - CD007577
LID - 10.1002/14651858.CD007577.pub2 [doi]
AB  - BACKGROUND: Pneumonia is the most common hospital-acquired infection affecting 
      patients in the intensive care unit (ICU). However, the optimal duration of 
      antibiotic therapy for hospital-acquired pneumonia (HAP) is uncertain. 
      OBJECTIVES: To assess the effectiveness of short versus prolonged-course 
      antibiotic administration for HAP in critically ill adults, including patients 
      with ventilator-associated pneumonia (VAP). SEARCH STRATEGY: We searched the 
      Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 
      2011, Issue 1), which includes the Cochrane Acute Respiratory Infections Group's 
      Specialised Register, MEDLINE (1950 to February week 4, 2011), EMBASE (1974 to 
      March 2011), LILACS (1985 to March 2011) and Web of Science (1985 to March 2011). 
      SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) 
      comparing fixed durations of antibiotic therapy, or comparing a protocol intended 
      to limit duration of therapy with standard care, for HAP (including patients with 
      VAP) in critically ill adults. DATA COLLECTION AND ANALYSIS: Two review authors 
      conducted data extraction and assessment of risk of bias. We contacted trial 
      authors for additional information. MAIN RESULTS: Eight studies (1703 patients) 
      were included. Methodology varied considerably and we found little evidence 
      regarding patients with a high probability of HAP who were not mechanically 
      ventilated. For patients with VAP, a short seven to eight-day course of 
      antibiotics compared with a prolonged 10 to 15-day course (three studies, N = 
      508) increased 28-day antibiotic-free days (odds ratio (OR) 4.02; 95% confidence 
      interval (CI) 2.26 to 5.78) and reduced recurrence of VAP due to multi-resistant 
      organisms (OR 0.44; 95% CI 0.21 to 0.95), without adversely affecting other 
      outcomes. However, for cases of VAP due to non-fermenting Gram-negative bacilli 
      (NF-GNB), recurrence was greater after short-course therapy (OR 2.18; 95% CI 1.14 
      to 4.16; two studies, N = 176), though other outcome measures did not 
      significantly differ. Discontinuation strategies utilising clinical features (one 
      study; N = 302) or procalcitonin (three studies; N = 323) led to a reduction in 
      duration of therapy and, in the procalcitonin studies, increased 28-day 
      antibiotic-free days (mean difference (MD) 2.80; 95% CI 1.39 to 4.21) without 
      negatively affecting other outcomes. AUTHORS' CONCLUSIONS: 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.
FAU - Pugh, Richard
AU  - Pugh R
AD  - Department of Anaesthetics, Glan Clwyd Hospital, Rhyl, Denbighshire, UK, LL18 
      5UJ.
FAU - Grant, Chris
AU  - Grant C
FAU - Cooke, Richard Pd
AU  - Cooke RP
FAU - Dempsey, Ged
AU  - Dempsey G
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20111005
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
CIN - Ann Intern Med. 2012 Mar 20;156(6):JC3-13. PMID: 22431699
UIN - Cochrane Database Syst Rev. 2015;8:CD007577. PMID: 26301604
MH  - Adult
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - *Critical Illness
MH  - Cross Infection/*drug therapy
MH  - Drug Administration Schedule
MH  - Humans
MH  - Intensive Care Units
MH  - Pneumonia/*drug therapy/microbiology
MH  - Pneumonia, Ventilator-Associated/drug therapy/microbiology
MH  - Randomized Controlled Trials as Topic
MH  - Time Factors
EDAT- 2011/10/07 06:00
MHDA- 2011/11/04 06:00
CRDT- 2011/10/07 06:00
PHST- 2011/10/07 06:00 [entrez]
PHST- 2011/10/07 06:00 [pubmed]
PHST- 2011/11/04 06:00 [medline]
AID - 10.1002/14651858.CD007577.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Oct 5;(10):CD007577. doi: 
      10.1002/14651858.CD007577.pub2.