Short-course antibiotic strategies for ventilator-associated pneumonia

Purpose of review Evidence behind antibiotic duration while treating ventilator-associated pneumonia (VAP) remains unclear. There is a need to balance minimizing the development of antimicrobial resistance without compromising clinical outcomes given the high mortality. Recent findings Recent studies have suggested that shorter antibiotic courses, when individualized to clinical response, may be adequate for treating VAP without increasing the incidence of mortality or recurrence, regardless of pathogens. Moreover, shortening duration may reduce the risk of adverse events, including acute kidney injury. Summary Shortening the duration of antibiotic treatment for VAP, in the setting of appropriate clinical response, is a reasonable strategy to reduce costs and selective pressure driving antimicrobial resistance. This was demonstrated in the latest REGARD-VAP study, even among VAP patients with nonfermenting Gram-negative bacilli or carbapenem-resistant pathogens. Given the challenges in diagnosing VAP, such pragmatic approaches would be essential as part of overall antibiotic stewardship programmes. Further refinement to the criteria for antibiotic cessation may be possible.