Short-course versus prolonged-course antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials
Cheema HA, Ellahi A, Hussain HU, et al., 2023 · 6 studies included
Summary
Across six randomized trials, short versus prolonged VAP antibiotic courses did not significantly change 28-day mortality, ICU length of stay or ventilation duration. In the subgroup with non-fermenting Gram-negative bacilli, shorter courses were associated with more recurrent pneumonia (RR 1.73, 95% CI 1.17–2.54); certainty was low for most outcomes.
Conclusion
About 7 days remains a reasonable default for clinically improving VAP, but duration should be individualized. Shorter response-guided courses can reduce antibiotic exposure in selected patients, while recurrence risk—particularly with non-fermenting Gram-negative pathogens—must be weighed rather than teaching one duration as universal.