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Chest. 2013 Dec;144(6):1759-1767. doi: 10.1378/chest.13-0076.

Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis.

Author information

1
Department of Critical Care, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
2
4th Department of Internal Medicine, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
3
The Department of Intensive Care, Medical School, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupoli, Greece.
4
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.
5
Department of Critical Care, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece. Electronic address: d.matthaiou@gmail.com.

Abstract

BACKGROUND:

We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).

METHODS:

We searched PubMed and Cochrane Central Registry of Controlled Trials. Four randomized controlled trials (RCTs) comparing short (7-8 days) with long (10-15 days) regimens were identified. Primary outcomes included mortality, antibiotic-free days, and clinical and microbiologic relapses. Secondary outcomes included mechanical ventilation-free days, duration of mechanical ventilation, and length of ICU stay.

RESULTS:

All RCTs included mortality data, whereas data on relapse and antibiotic-free days were provided in three and two out of four RCTs, respectively. No difference in mortality was found between the compared arms (fixed effect model [FEM]: OR = 1.20; 95% CI, 0.84-1.72; P = .32). There was an increase in antibiotic-free days in favor of the short-course treatment with a pooled weighted mean difference of 3.40 days (random effects model: 95% CI, 1.43-5.37; P < .001). There was no difference in relapses between the compared arms, although a strong trend to lower relapses in the long-course treatment was observed (FEM: OR = 1.67; 95% CI, 0.99-2.83; P = .06). No difference was found between the two arms regarding the remaining outcomes. Sensitivity analyses yielded similar results.

CONCLUSIONS:

Short-course treatment of VAP was associated with more antibiotic-free days. No difference was found regarding mortality and relapses; however, a strong trend for fewer relapses was observed in favor of the long-course treatment, being mostly driven by one study in which the observed relapses were probably more microbiologic than clinical. Additional research is required to elucidate the issue.

PMID:
23788274
DOI:
10.1378/chest.13-0076
[Indexed for MEDLINE]

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