Shorter Antibiotic Regimens Recommended for Treatment of Pneumonia

For the first time since 2005, the Clinical Practice Guidelines related to hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), issued by the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) have been updated. New changes in the guidelines recommend that each hospital generate HAP/VAP-patient specific antibiograms and reduce the use of antibiotics in treatment regimens.

Hospital-acquired pneumonia (HAP) is defined by the ATS as pneumonia, an infection of the lungs, that is contracted by the patient 48 hours or more after hospital admission, that had not been incubating at the time of admission. VAP is a lung infection that develops in a person using ventilator assistance. A ventilator is a machine that helps patients breathe by providing oxygen through a tube that can be placed in a person’s nose, mouth, or hole in the front of the neck, according to the Centers for Disease Control and Prevention (CDC). VAP occurs more than 48-72 hours after endotracheal intubation. HAP and VAP remain important causes of morbidity and mortality, making hygiene practices within the healthcare setting even more important.

According to the Cleveland Medical Clinic, HAP, occurring at a rate of 5 to 15 cases per 1,000 hospital admissions, is the second most prevalent infection in the United States originating in healthcare settings and is typically linked with a high mortality rate; as a result, 90% of mechanically-ventilated patients end up being diagnosed with VAP. According to a recent press release by IDSA, 20% to 25% of hospital-acquired infections (HAIs) are HAP and VAP.

The new guidelines recommend different treatment lengths for antibiotic therapy than previously published in 2005. According to a press release, the guidelines panel recommends up to 7 days of antibiotic therapy for many different types of bacteria. Andre C. Kalil, MD, MPH, lead author of the guidelines, professor of medicine in the Division of Infectious Diseases and director of the Transplant Infectious Diseases Program at the University of Nebraska Medical Center, stresses that reducing the duration of antibiotic use will not reduce therapy benefits, but can reduce antibiotic-related side effects. He stated, “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… This helps individuals care, ensuring patients will be treated with the correct antibiotic as soon as possible.”

Ideally, as a way to ensure safe, optimal care and limit the development of antibiotic resistance, the guideline panel recommends for hospitals to create HAP or VAP patient-specific antibiograms. However, the panel acknowledged that the generation of individual-specific antibiograms might not be feasible for hospitals that do not do routine surveillance for HAP. In such cases, they recommend that the antibiograms should be specific to individual intensive care units within each hospital. These antibiograms can be used to reduce the use of unnecessary antibiotics as well as decrease antibiotic resistance.

According to the guidelines published by Clinical Infectious Diseases, “The guideline panel agreed that the use of local antibiograms to inform antibiotic selection is the preferred approach to initiating early appropriate antibiotic coverage while avoiding superfluous treatment.”

Other notable changes that have been made to the guidelines since 2005 include: “the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for evaluation of all available evidence; [and] the removal of the concept of healthcare-associated pneumonia (HCAP),” according to the published guidelines available online.