Monday November 10, 2008
Do we need 8 or 15 days of antibiotics for Ventilator Associated Pneumonia

Chastre and his colleague look at the difference between 8 or 15 days of antibiotics use. Decreasing the duration of antibiotics can help to decrease the resistance.

DESIGN, SETTING, AND PARTICIPANTS: Prospective, randomized, double-blind (until day 8) clinical trial conducted in 51 French ICUs.

A total of 401 patients diagnosed as having developed VAP by quantitative culture results of bronchoscopic specimens and who had received initial appropriate empirical antimicrobial therapy were enrolled between May 1999 and June 2002.

INTERVENTION: A total of 197 patients were randomly assigned to receive 8 days and 204 to receive 15 days of therapy with an antibiotic regimen selected by the treating physician.

MAIN OUTCOME MEASURES: Primary outcome measures-death from any cause, microbiologically documented pulmonary infection recurrence, and antibiotic-free days-were assessed 28 days after VAP onset and analyzed on an intent-to-treat basis.

RESULTS: Compared with patients treated for 15 days, those treated for 8 days had

• neither excess mortality (18.8% vs. 17.2%) nor more recurrent infections (28.9% vs. 26.0%)
• The number of mechanical ventilation-free days, the number of organ failure-free days, the length of ICU stay, and mortality rates on day 60 for the 2 groups did not differ.
• Although patients with VAP caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when antimicrobial therapy lasted only 8 days, they did have a higher pulmonary infection-recurrence rate compared with those receiving 15 days of treatment (40.6% vs. 25.4%).

CONCLUSIONS: Among patients who had received appropriate initial empirical therapy, with the possible exception of those developing nonfermenting gram-negative bacillus infections, comparable clinical effectiveness against VAP was obtained with the 8- and 15-day treatment regimens. The 8-day group had less antibiotic use.



Reference: click to get abstract/article

Chastre J, Wolf M, Fago JY et al. Comparision of 8 vs 15 days of antibiotic therapy for ventilator associated pneumonia in adults. JAMA 2003; 290: 2588-2598.