Short-course antibiotics okay for hospital-acquired, ventilator-associated pneumonia

By Will Boggs MD

NEW YORK (Reuters Health) - Most adults with hospital-acquired (HAP) or ventilator-associated pneumonia (VAP) should receive seven days of antibiotic treatment, according to revised guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS).

"While this course provides safe and efficacious treatment to most patients with pneumonia, it can also reduce unnecessary exposure to antibiotics and their side effects, reduce the development of C. diff. diarrhea, reduce the development of bacterial resistance, and lower costs to both patients and society," lead author Dr. Andre C. Kalil from University of Nebraska Medical Center in Omaha told Reuters Health by email.

Together, HAP and VAP account for more than 20% of all hospital-acquired infections, and mortality related to these infections can reach 50%, Dr. Kalil and colleagues note in an article online July 14 in Clinical Infectious Diseases.

The team used data from reports identified by a literature search to develop revised guidelines for the management of HAP and VAP in adults, labeling their 25 recommendations according to the GRADE approach.

They recommend that empiric treatment regimens be informed by the local distribution of pathogens and their antimicrobial susceptibilities, and to facilitate that process, each hospital should generate antibiograms specific to that institution.

"The routine use of antibiograms in each individual hospital and ICU will provide clinicians a very useful tool to start the most appropriate empiric antibiotics as early as possible; this will lead to a more precise and individualized patient care," Dr. Kalil said.

They also recommend short-course antibiotic therapy (seven days) for most patients with HAP or VAP, independent of microbial etiology.

The empiric antibiotic regimen should be changed to a narrower antibiotic regimen once the causative agent has been identified, rather than maintaining a broad-spectrum antibiotic regimen until therapy is completed.

"The recommendation of antibiotic de-escalation is another important recommendation because it will prioritize the optimal length of therapy and further reduce the unnecessary continuation of antibiotics and their harmful consequences," Dr. Kalil said.

The guidelines also include advice on initial empiric antibiotic therapy, pathogen-specific therapy, inhaled antibiotic therapy, and methods for diagnosing VAP and HAP.

"Health care providers taking care of patients with HAP/VAP should take full advantage of the new guideline recommendations, but always adapting the new recommendations to each individual patient's needs," Dr. Kalil concluded.

SOURCE: http://bit.ly/29UH5Ag

Clin Infect Dis 2016.

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