Led by Dr Mo Yin from the Infectious Diseases Translational Research Programme at the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine) and Consultant from the Division of Infectious Diseases in the Department of Medicine at National University Hospital (NUH), the 4-year long REducinG Antibiotic tReatment Duration for Ventilator-Associated Pneumonia (REGARD-VAP) study involved 460 patients in 39 hospital intensive care units (ICUs) in Nepal, Thailand and Singapore.

VAP is a common lung infection among critically ill patients in hospital ICUs, who are dependent on ventilators to breathe. It occurs when bacteria invade the lower respiratory tract and thin lung tissues via the breathing tube. The infection leads to longer hospital stays, increased antibiotic use, and the risk of death is as much as 40%. While personalised short-course treatment duration for patients with 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%.

460 patients with VAP were randomly assigned into two groups—a 3-to-5-day individualised, short-course antibiotic treatment plan, and a longer standard-of-care treatment plan of at least 8 days. 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 within 60 days of enrolling into the study. 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.

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 3 to 5 days of receiving VAP treatment. For patients in the standard care duration group, the antibiotic treatment strategy lasted at least 8 days, as determined by their primary physicians. Current standard-of-care antibiotic treatment can last up to 2 to 3 weeks, accompanied by higher risks of side effects and unnecessary economic costs.

The study’s findings serve as a point of reference for antibiotic usage reduction and titration, so that the onset of antibiotic resistance can be prevented.