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New guideline for HAP, VAP recommends shortened antibiotic therapy
The Infectious Diseases Society of America and the American Thoracic Society have released a new clinical guideline for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia.
The guideline, which updates those published in 2005, recommends shortening the duration of antibiotic therapies for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) to 7 days, and advocates the use of antibiograms to ensure appropriate antibiotics are selected for these patients.
“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,” Andre C. Kalil, MD, MPH, professor of medicine in the infectious diseases division and director of the transplant infectious diseases program at the University of Nebraska Medical Center, Omaha, said in a press release. “This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible.”
Kalil, along with Infectious Disease News Editorial Board member Thomas M. File Jr., MD, and a multidisciplinary team of 18 other experts, reviewed published data regarding the diagnosis and treatment of HAP and VAP. They rated evidence as either “weak” or “strong” using the GRADE system of evidence evaluation, and provided recommendations or suggestions based on discussions of the data. All of the panel’s recommendations were reviewed and endorsed by the two leading societies, as well as by the Society of Critical Care Medicine and the Society for Healthcare Epidemiology of America.
Although the previous recommendations advocated different antibiotic therapy durations depending on the bacterium responsible for the infection, the panel advised limiting HAP/VAP patients’ therapies to 7 or fewer days and only employing longer treatments when necessary. This recommendation is based on evidence suggesting no detriment to shorter courses, Kalil said in the release, and would reduce the impact of various antibiotic-related side effects.
In addition, the experts recommend the use of antibiograms specific to ICU patients, describe the optimal therapies for various HAP/VAP presentations, offer guidance on the use of empiric regimens and suggest dosing by pharmacokinetic/pharmacodynamic data as opposed to manufacturer’s prescribing information.
The new guideline is not recommended for immunocompromised patients with opportunistic pulmonary infection, the panel members wrote, as these patients often require alternative diagnosis and treatments. – by Dave Muoio
- Reference:
- Kalil AC, et al. Clin Infect Dis. 2016;doi:10.1093/cid/ciw353.
Disclosures: Kalil reports no relevant financial disclosures. File reports the receipt of FDA grants during the study, as well as relationships with Allergan, Cempra, Melinta, Merck, MotifBio, Nabriva, Pfizer, Tetraphase and Sensor Kenesis Group. Please see the full guideline for a list of all other authors’ relevant financial disclosures.