PMID- 26301604 OWN - NLM STAT- MEDLINE DCOM- 20160301 LR - 20220810 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 2015 IP - 8 DP - 2015 Aug 24 TI - Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. PG - CD007577 LID - 10.1002/14651858.CD007577.pub3 [doi] LID - CD007577 AB - BACKGROUND: Pneumonia is the most common hospital-acquired infection affecting patients in the intensive care unit (ICU). However, current national guidelines for the treatment of hospital-acquired pneumonia (HAP) are several years old and the diagnosis of pneumonia in mechanically ventilated patients (VAP) has been subject to considerable recent attention. The optimal duration of antibiotic therapy for HAP in the critically ill is uncertain. OBJECTIVES: To assess the effectiveness of short versus prolonged-course antibiotics for HAP in critically ill adults, including patients with VAP. SEARCH METHODS: We searched CENTRAL (2015, Issue 5), MEDLINE (1946 to June 2015), MEDLINE in-process and other non-indexed citations (5 June 2015), EMBASE (2010 to June 2015), LILACS (1982 to June 2015) and Web of Science (1955 to June 2015). SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) comparing a fixed 'short' duration of antibiotic therapy with a 'prolonged' course 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: We identified six relevant studies involving 1088 participants. This included two new studies published after the date of our previous review (2011). There was substantial variation in participants, in the diagnostic criteria used to define an episode of pneumonia, in the interventions and in the reported outcomes. We found no evidence relating to patients with a high probability of HAP who were not mechanically ventilated. For patients with VAP, overall a short seven- or eight-day course of antibiotics compared with a prolonged 10- to 15-day course increased 28-day antibiotic-free days (two studies; N = 431; mean difference (MD) 4.02 days; 95% confidence interval (CI) 2.26 to 5.78) and reduced recurrence of VAP due to multi-resistant organisms (one study; N = 110; odds ratio (OR) 0.44; 95% CI 0.21 to 0.95), without adversely affecting mortality and other recurrence outcomes. However, for cases of VAP specifically due to non-fermenting Gram-negative bacilli (NF-GNB), recurrence was greater after short-course therapy (two studies, N = 176; OR 2.18; 95% CI 1.14 to 4.16), though mortality outcomes were not significantly different. One study found that a three-day course of antibiotic therapy for patients with suspected HAP but a low Clinical Pulmonary Infection Score (CPIS) was associated with a significantly lower risk of superinfection or emergence of antimicrobial resistance, compared with standard (prolonged) course therapy. AUTHORS' CONCLUSIONS: On the basis of a small number of studies and appreciating the lack of uniform definition of pneumonia, we conclude that for patients with VAP not due to NF-GNB a short, fixed course (seven or eight days) of antibiotic therapy appears not to increase the risk of adverse clinical outcomes, and may reduce the emergence of resistant organisms, compared with a prolonged course (10 to 15 days). However, for patients with VAP due to NF-GNB, there appears to be a higher risk of recurrence following short-course therapy. These findings do not differ from those of our previous review and are broadly consistent with current guidelines. There are few data from RCTs comparing durations of therapy in non-ventilated patients with HAP, but on the basis of a single study, short-course (three-day) therapy for HAP appears not to be associated with worse clinical outcome, and may reduce the risk of subsequent infection or the emergence of resistant organisms when there is low probability of pneumonia according to the CPIS. 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 P D AU - Cooke RP FAU - Dempsey, Ged AU - Dempsey G LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20150824 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 RN - 0 (Anti-Bacterial Agents) SB - IM UOF - Cochrane Database Syst Rev. 2011;(10):CD007577. PMID: 21975771 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 PMC - PMC7025798 COIS- There were no sources of funding for this review. Richard Pugh: none known.
 Chris Grant: none known.
 Richard PD Cooke: none known.
 Ged Dempsey: none known. EDAT- 2015/08/25 06:00 MHDA- 2016/03/02 06:00 PMCR- 2016/08/24 CRDT- 2015/08/25 06:00 PHST- 2015/08/25 06:00 [entrez] PHST- 2015/08/25 06:00 [pubmed] PHST- 2016/03/02 06:00 [medline] PHST- 2016/08/24 00:00 [pmc-release] AID - CD007577.pub3 [pii] AID - 10.1002/14651858.CD007577.pub3 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2015 Aug 24;2015(8):CD007577. doi: 10.1002/14651858.CD007577.pub3.