Short- versus long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis.
Chest. 2013 Jun 20;
Authors: Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK
ABSTRACT BACKGROUND: We performed a systematic review and meta-analysis of short- versus 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, clinical and microbiological 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 on 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): Odds Ratio (OR)=1.20, 95% Confidence Interval(CI) 0.84-1.72, p=0.32). 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 to 5.37, p<0.001). 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=0.06). No difference was found between the two arms regarding the remaining outcomes. Sensitivity analyses yielded similar results.
CONCLUSIONS: Short-course treatment for VAP was associated with more antibiotic-free days. No difference was found regarding mortality and relapses; however a strong trend for less relapses was observed in favor of the long-course treatment, being mostly driven by one study in which the observed relapses were probably more microbiological than clinical. Additional research is required to elucidate the issue.
PMID: 23788274 [PubMed - as supplied by publisher]