New Guidelines Back Reduced Antibiotic Use for Hospital-Acquired Pneumonia

Experts recommend seven or fewer days of therapy

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)––which account for 20% to 25% of hospital-acquired infections––should be treated with shorter courses of antibiotics than they typically are, according to new guidelines released by the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) and published in Clinical Infectious Diseases. The recommendation of seven or fewer days of antibiotics for most of these infections reflects a change from previous guidelines to ensure safe and effective treatment while limiting the development of antibiotic resistance.

Created by a multidisciplinary panel led by infectious disease, pulmonary, and critical care specialists, the new guidelines also recommend that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia infections locally as well as which antibiotics effectively treat them. When possible, the antibiogram should be specific to the hospital’s intensive care unit patients, according to the guidelines. Antibiograms should be updated regularly, and the most appropriate frequency should be 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,” said lead author Andre C. Kalil, MD, MPH, of the University of Nebraska Medical Center in Omaha. “This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible.”

Published in 2005, previous guidelines recommended different lengths of treatment for antibiotic therapy based on the bacterium causing the infection. The 2016 guidelines recommend seven days or fewer for all bacteria. Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy; in addition, it can reduce antibiotic-related adverse effects, the risk of Clostridium difficile infection, a serious diarrheal infection, antibiotic resistance, and costs, Kalil said. In some cases, such as when a patient doesn’t improve or worsens, longer treatment may be necessary.

Mechanical ventilators are used when a patient is having surgery with general anesthesia or for those with impaired lung function. One of every 10 patients on a ventilator gets VAP, which is fatal about 13% of the time. VAP also increases the amount of time patients remain on a ventilator (from 7.6 to 11.5 days, on average) and the length of hospital stay (from 11.5 to 13.1 days, on average). While HAP is usually a less-severe infection, half of patients experience serious complications, including respiratory failure, fluid in the lungs, septic shock, and kidney failure.

Source: Medical Xpress; July 14, 2016.