Less Is More: A 7-Day Course of Antibiotics Is the Evidence-Based Treatment for<i>Pseudomonas aeruginosa</i>Ventilator-Associated Pneumonia
Mark L. Metersky, Michael Klompas, André C. Kalil
Abstract
(See the Viewpoints Article by Albin et al on pages 745–9.) Recommendations for the length of antimicrobial therapy for ventilator-associated pneumonia (VAP) due to Pseudomonas aeruginosa (PsA) have changed over time. The PneumA study, published in 2003, found similar overall outcomes in patients with VAP treated with 8 versus 15 days, but a potentially increased risk of VAP recurrence with 8-day regimens in patients with VAP due to nonfermenting gram-negative bacilli (NF-GNB) [1]. The PneumA study triggered a change in treatment guidelines from 14–21 days [2] to 7 days for most organisms except for NF-GNB, which remained 14–21 days due to the perceived increased risk of recurrence among these patients [3]. In 2016, this recommendation was re-examined in the updated guidelines, in light of evidence that clinically meaningful patient-centered outcomes were similar in patients with PsA-VAP who received short- versus long-course therapy; 7 days of antibiotic therapy is now recommended for all bacteria as long as the patient is responding to treatment [4].