Pneumonia · Duration of antibiotic therapy
Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia
| Design | Randomised, double-blind, non-inferiority trial |
|---|---|
| Treatment | 8 days of antibiotic therapy |
| Control | 15 days of antibiotic therapy |
| Population | 401 patients with microbiologically confirmed ventilator-associated pneumonia who had received appropriate initial empirical therapy |
| Follow-up | 28 days |
| Primary endpoint | Death from any cause, recurrent infection and antibiotic-free days |
| Result | Mortality 18.8% with 8 days versus 17.2% with 15 days (difference 1.6%, 90% CI -3.7% to 6.9%). Recurrent infection 28.9% versus 26.0% (difference 2.9%, 90% CI -3.2% to 9.1%). Antibiotic-free days 13.1 versus 8.7 (p<0.001). Ventilator-free days, organ failure-free days and ICU stay did not differ. Recurrence was higher with 8 days in non-fermenting gram-negative infection. |
| Secondary endpoints | Ventilator-free days, organ failure-free days, ICU length of stay, antibiotic use |
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.
The trial authors, in the published abstract
The foundation of short-course antibiotic therapy, and the origin of the Pseudomonas caveat that still appears in every guideline. Its condition — appropriate initial empirical therapy — is easy to overlook and is doing real work in the result.
Chastre J, Wolff M, Fagon JY, 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(19):2588-98.