Omaha, NE—For most hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) infections, 7 days of antibiotics usually are effective enough, according to new treatment guidelines.
The new guidelines issued by the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS), published recently in the journal Clinical Infectious Diseases, recommend shorter courses of antibiotics than traditionally have been used because of concerns about antibiotic resistance, as well as the risk of Clostridium difficile infection, which is often related to antibiotic use.
Background information in the article notes that HAP and VAP account for 20% to 25% of hospital-acquired infections.
The multidisciplinary panel developing the new guidelines, led by Andre C. Kalil, MD, MPH, 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, also recommends that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia infections locally and which antibiotics effectively treat them.
The antibiogram should be specific to the hospital’s intensive care unit patients, according to the guidelines, and should be updated regularly, with the most appropriate frequency determined by the institution, the guidelines note.
“Once clinicians are updated regularly on what bugs are causing VAP and HAP in their hospitals as well as their sensitivities to specific antibiotics, they can choose the most effective treatment,” Kalil said in an IDSA press release. “This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible.”
Previous guidelines, last released in 2005, recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection. While the new guidelines recommend seven days or fewer for all bacteria, they leave open the possibility of lengthening therapy if the patient doesn’t improve or gets worse.
Using evidence from patients with VAP, the panel concludes that antibiotic therapy for seven days or less “does not reduce the benefits of antibiotic therapy; however, the shorter duration of therapy almost certainly reduces antibiotic-related side effects, C. difficile colitis, the acquisition of antibiotic resistance and costs.”
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