Less is more – shortened antibiotic treatment for ventilator-associated pneumonia in ICU patients just as effective as standard course
Published: 26 Jan 2024
Dr Mo Yin (second from left) discussing a patient’s case with local doctors in Sri Lanka during a site visit in January 2024.
Less is also better – that is what researchers have found while conducting a tri-nation clinical trial to see if shorter courses of antibiotics are as effective as longer prescriptions of the drug to treat ventilator-associated pneumonia.
Led by Dr Mo Yin from the Infectious Diseases Translational Research Programme and a consultant in the Division of Infectious Diseases in the Department of Medicine at the National University Hospital, the four-year long REducing Antibiotic tReatment Duration for Ventilator-Associated Pneumonia (REGARD-VAP) study involved 460 patients in 39 hospital intensive care units in Nepal, Thailand and Singapore. While personalised short-course treatment duration for patients with ventilator-associated pneumonia (VAP) was just as effective in reducing the duration of pneumonia in comparison to the standard treatment duration, the short-course treatment strategy also successfully reduced antibiotic side effects from 38%, to 8%.
The 460 patients with VAP were randomly assigned into two groups – a three-to-five day individualised, short-course antibiotic treatment plan and a longer, standard-of-course treatment plan of a minimum eight days. Participants were reviewed daily to assess if they met the criteria to stop antibiotics; the criteria included a core body temperature of less than or equal to 38.3 degree Celsius for 48 hours and a stable blood pressure.
When the criteria were met, all participants in the short-course treatment strategy group were weaned off antibiotics after three to five days of receiving VAP treatment. Of the 460 participants, 41% in the individualised short-course group and 44% in the standard-of-care group either died or had pneumonia recurrence.
The main aim was to determine if the individualised short-course strategy is non-inferior to the usual standard-of-care duration, in terms of the increased risk of death or the recurrence of pneumonia happening within 60 days of enrolling into the study.
VAP is a common lung infection among critically ill patients in hospital intensive care units, who are dependent on ventilators to breathe. The infection leads to longer hospital stays, increased antibiotic use, and the risk of death is as much as 40%.
The REGARD-VAP clinical trial was jointly funded by the Singapore National Medical Research Council and the United Kingdom Medical Research Council. The paper is titled Reducing antibiotic treatment duration for ventilator-associated pneumonia (REGARD-VAP): a trial protocol for a randomised clinical trial, and was published in the Lancet Respiratory Medicine on 23 January 2024.
Read the media release here.
