title: Early-onset ventilator-associated pneumonia in adults randomized clinical trial: comparison of 8 versus 15 days of antibiotic treatment.
abstract: OBJECTIVE
  The optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria.
  
  
  OBJECTIVE
  To demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia.
  
  
  METHODS
  Randomized, prospective, open, multicenter trial carried out from 1998 to 2002.
  
  
  METHODS
  The primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90.
  
  
  RESULTS
  225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [-8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90.
  
  
  CONCLUSIONS
  Our results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01559753.
authors.affiliation: Réanimation médicale adulte, Pôle Urgences-SAMU-Réanimation CHU, Besancon, Doubs, France. gilles.capellier@univ-fcomte.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
authors.forename: Hélène
authors.initials: H
authors.lastname: Mockly
authors.forename: Claire
authors.initials: C
authors.lastname: Charpentier
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.forename: Gilles
authors.initials: G
authors.lastname: Blasco
authors.forename: Thibault
authors.initials: T
authors.lastname: Desmettre
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Christophe
authors.initials: C
authors.lastname: Faisy
authors.forename: Joel
authors.initials: J
authors.lastname: Cousson
authors.forename: Samuel
authors.initials: S
authors.lastname: Limat
authors.forename: Mariette
authors.initials: M
authors.lastname: Mercier
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D018893:Bronchoalveolar Lavage; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000209:etiology; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents