Short-course versus long-course antibiotic treatment for ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials

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RATIONALE Current guidelines recommend a short course of antibiotic therapy for ventilator-associated pneumonia (VAP) caused by nonfermenting gram-negative bacilli (NF-GNB). However, this approach has been associated with an increased risk of pneumonia recurrence.OBJECTIVE This meta-analysis aims to address inconsistencies in the literature and evaluate the efficacy of short-course versus long-course antibiotic therapy for VAP, particularly in NF-GNB cases.METHODS We systematically searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception through August 2024 for randomized controlled trials (RCTs) comparing short versus long courses of antibiotic therapy in patients with VAP.MEASUREMENTS The primary outcomes were the risk of all-cause mortality and pneumonia recurrence. For all-cause mortality, an absolute noninferiority margin of 10% was chosen. Data were analyzed using RevMan 5.4, with risk ratio (RR) and mean difference (MD) as effect measures.RESULTS Our pooled analysis included seven RCTs (1519 patients, 583 with NF-GNB VAP). There was no significant difference in all-cause mortality between short- and long-course antibiotic regimens (RR 1.02; 95% CI: 0.88–1.18). The absolute risk difference was 1% (95% CI: −3 to 6%), indicating that noninferiority was met. A short course of antibiotics increased the incidence of pneumonia recurrence in patients with VAP due to NF-GNB (RR 1.64; 95% CI: 1.18–2.29).CONCLUSIONS Our meta-analysis suggests that while a short course of antibiotics increases the risk of pneumonia recurrence in NF-GNB VAP, it is noninferior to a longer course with regard to all-cause mortality. Further RCTs are needed to draw definitive conclusions in this population.

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