title: Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis.
abstract: BACKGROUND
  We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).
  
  
  METHODS
  We searched PubMed and Cochrane Central Registry of Controlled Trials. Four randomized controlled trials (RCTs) comparing short (7-8 days) with long (10-15 days) regimens were identified. Primary outcomes included mortality, antibiotic-free days, and clinical and microbiologic relapses. Secondary outcomes included mechanical ventilation-free days, duration of mechanical ventilation, and length of ICU stay.
  
  
  RESULTS
  All RCTs included mortality data, whereas data on relapse and antibiotic-free days were provided in three and two out of four RCTs, respectively. No difference in mortality was found between the compared arms (fixed effect model [FEM]: OR = 1.20; 95% CI, 0.84-1.72; P = .32). There was an increase in antibiotic-free days in favor of the short-course treatment with a pooled weighted mean difference of 3.40 days (random effects model: 95% CI, 1.43-5.37; P &lt; .001). There was no difference in relapses between the compared arms, although a strong trend to lower relapses in the long-course treatment was observed (FEM: OR = 1.67; 95% CI, 0.99-2.83; P = .06). No difference was found between the two arms regarding the remaining outcomes. Sensitivity analyses yielded similar results.
  
  
  CONCLUSIONS
  Short-course treatment of VAP was associated with more antibiotic-free days. No difference was found regarding mortality and relapses; however, a strong trend for fewer relapses was observed in favor of the long-course treatment, being mostly driven by one study in which the observed relapses were probably more microbiologic than clinical. Additional research is required to elucidate the issue.
authors.affiliation: Department of Critical Care, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: 4th Department of Internal Medicine, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
authors.forename: Garyphallia
authors.initials: G
authors.lastname: Poulakou
authors.affiliation: The Department of Intensive Care, Medical School, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupoli, Greece.
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Pneumatikos
authors.affiliation: Department of Critical Care, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
authors.affiliation: Department of Critical Care, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece. Electronic address: d.matthaiou@gmail.com.
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Matthaiou
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007902:Length of Stay; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology*; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents