IDSA: Shorter Courses of Antibiotics Safe for Treating HAP, VAP

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The 2016 guidelines recommend seven days or fewer for all bacteria.
The 2016 guidelines recommend seven days or fewer for all bacteria.

Shorter courses of antibiotics — 7 days or less — are likely sufficient for hospital-acquired and ventilator-associated pneumonia, according to updated guidelines from the American Thoracic Society and Infectious Diseases Society of America.

Created by a multidisciplinary panel led by infectious disease, pulmonary, and critical care specialists, the new guidelines also recommend that each hospital develop an antibiogram, a regular analysis of the strains of bacteria locally causing pneumonia infections  as well as which antibiotics effectively treat them. When possible, the antibiogram should be specific to the hospital's intensive care unit patients.1

"Once clinicians are updated regularly on what bugs are causing ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in their hospitals as well as their sensitivities to specific antibiotics,  they can choose the most effective treatment," Andre C. Kalil, MD, MPH, lead author of the guidelines, professor of medicine in the Division of Infectious Diseases and director of the Transplant Infectious Diseases Program at the University of Nebraska Medical Center, Omaha, said in a press release.2 "This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible."

Published in 2005, the previous guidelines recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection. The 2016 guidelines recommend 7 days or less for all bacteria.

Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy. In addition, this can reduce antibiotic-related adverse events.

According to the release provided by the Infectious Diseases Society of America, “One of every 10 patients on a ventilator gets VAP, which is fatal about 13% of the time. VAP also increases: the amount of time patients remain on a ventilator — from 7.6 to 11.5 days on average — and; length of hospital stay — from 11.5 to 13.1 days on average. While HAP typically is a less-severe infection, half of patients have serious complications, including respiratory failure, fluid in the lungs, septic shock and kidney failure.” 

References

1. Kalil AC, Metersky ML, Klompas M, et al.  Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis J. 2016; doi: 10.1093/cid/ciw353.

2. Shorter Courses of Antibiotics Safe for Treatment of Patients with Hospital-Acquired, Ventilator-Associated Pneumonia [press release]. Arlington, VA: Infectious Diseases Society of America; July 14, 2016.

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