Spectrum: Local Antimicrobial Stewardship, for Eastern Health

Ventilator Acquired Pneumonia (VAP) Duration of Therapy

Recommended Duration

7 days

VAP Management

Shortest Duration

Minimum duration studied without evidence of reduced efficacy

3 days (Applies to VAP with no derangement in oxygen exchange - see below)

Excluded Patients

  • Severely immunosuppressed patients

  • CF patients

  • Patients with collections or abscesses

  • Patients with S. aureus bacteremia associated with VAP

Additional Notes

  • European guidelines recommend 7-8 days, depending on patient improvement

  • Sentinel RCT's have been followed by confirmatory analysis and guideline endorsement

  • Previous concerns about requirements for longer therapy have been reassessed in light of the understanding that most “relapse” was recolonization, and likely not true disease

  • More recent studies of shorter durations (3d) have been limited to mild disease and likely are not applicable to more severe VAP

  • Adapted from AMMI Canada Position Statement on the Appropriate Duration of Antimicrobial Therapy (2018)

More Information

References
  1. Dimopoulos G, Garaphallia P, Pneumatikos I et al., Short- vs Long-Duration Antibiotic Regimensfor Ventilator-Associated Pneumonia, A Systematic Review and Meta-analysis. Chest 144(6):1759-67. 2013
  2. Pugh, R., Grant, C., Cooke, R. P. & Dempsey, G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev CD007577 (2015)