Lancet Respir Med

Trial examines shorter antibiotic courses for ventilator-associated pneumonia

February 5, 2024

Individualized shortened antibiotic duration guided by clinical response was non-inferior to longer treatment durations in terms of 60-day mortality and pneumonia recurrence and was associated with substantially reduced antibiotic use and side effects.

• The REGARD-VAP trial enrolled 461 adults (age ≥18 years) who met the CDC and Prevention National Healthcare Safety Network criteria for VAP, had been mechanically ventilated for ≥48 hours, and were administered culture-directed antibiotics. Participants were randomly assigned to a short-course treatment group (n=232) or a standard of care group (n=229). Median age was 64 years and 181 (39%) participants were female. 435 individuals were included in the final study. Primary outcome was a composite of death or pneumonia recurrence at 60 days.
• Median antibiotic treatment duration for the index episodes of VAP was 6 days in the short-course group and 14 days in the usual care group.
• 95 (41%) of 231 participants in the short-course group met the primary outcome, compared with 100 (44%) of 229 in the usual care group. Results were similar in the per-protocol population.
• Non-inferiority of short-course antibiotic treatment was met, although superiority compared with usual care wasn't established.
• In the per-protocol population, antibiotic side effects occurred in 38% of participants in the usual care group and 8% in the short-course group.
• Authors concluded that individualized, short-course antibiotic treatment for VAP could help to reduce the burden of side effects and the risk of antibiotic resistance in high-resource and resource-limited settings.

Source:

Mo Y, et al; REGARD-VAP investigators. (2024, January 22). Lancet Respir Med. Individualised, short-course antibiotic treatment versus usual long-course treatment for ventilator-associated pneumonia (REGARD-VAP): a multicentre, individually randomised, open-label, non-inferiority trial. https://pubmed.ncbi.nlm.nih.gov/38272050/