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Eight-Day Antibiotic Regimen for Ventilator-Associated Pneumonia

Shorter antibiotic courses didn't increase mortality and recurrent infection rates.

Intensive care units breed drug-resistant bacteria, partly because of the broad-spectrum antibiotics that are used routinely in these settings. French investigators sought to determine whether lessening ICU antibiotic use by halving the usual treatment duration for ventilator-associated pneumonia (VAP) would address this problem.

Researchers enrolled 401 intubated patients with bacterial VAP (confirmed bronchoscopically by cultures from bronchoalveolar lavage fluid or protected-brush specimens) from 51 participating hospitals in France. Patients were randomized in a double-blind protocol to receive antibiotics for either 8 or 15 days. Only patients who had developed pneumonia while being ventilated were included; exclusion criteria included neutropenia, immunocompromised status, do-not-resuscitate status, and low chance of survival as determined by a standard index. The patients' treating physicians chose antibiotics according to standard criteria. Relapses and superinfections were investigated with repeat bronchoscopy.

Mortality rates within 28 days after VAP onset were similar in patients who were treated for 8 days or for 15 days; overall rates of recurrent infections and lengths of ICU stay also were similar between these groups. A disadvantage of briefer treatment was seen only in patients who had pneumonia caused by non-lactose fermenting gram-negative rods (e.g., pseudomonas), in whom the 8-day regimen was associated with significantly greater likelihood of relapse.

Comment: Findings of this impressive study suggest that, for many ICU patients, VAP can be treated safely with a short course of antibiotics. However, patients who are infected with difficult-to-treat organisms such as pseudomonas must be watched carefully for relapse, and this study's results do not apply to terminally ill or immunocompromised patients.

— Abigail Zuger, MD

Published in Journal Watch General Medicine January 6, 2004

Citation(s):

Chastre J et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: A randomized trial. JAMA 2003 Nov 19; 290:2588-98.

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