Cochrane · systematic review · CD007577
Short‐course versus prolonged‐course antibiotic therapy for hospital‐acquired pneumonia in critically ill adults
Pugh, R, Grant, C, Cooke, RPD, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
7
current version
GRADE rated
7
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 3 · 42.9%Moderate 4 · 57.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyShould short‐course antibiotic therapy versus prolonged‐course antibiotic therapy be used in critically ill patients with hospital‐acquired pneumonia?
Population: hospital‐acquired pneumonia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.18 [0.77, 1.8] | 3 studies · 598 participants | Moderate |
Mortality NF‐GNB Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 0.95 [0.39, 2.27] | 2 studies · 179 participants | Low |
Mortality MRSA Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.28 [0.32, 5.09] | 1 study · 42 participants | Moderate |
Recurrence of pneumonia Clinical and/or microbiological criteria Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.41 [0.94, 2.12] | 19 studies · 733 participants | Low |
Recurrence of pneumonia NF‐GNB Clinical and/or microbiological criteria Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 2.18 [1.14, 4.16] | 2 studies · 176 participants | Moderate |
Recurrence of pneumonia MRSA Clinical and/or microbiological criteria Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.56 [0.12, 19.61] | 2 studies · 49 participants | Moderate |
28‐day antibiotic‐free days Should short‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | no estimate extracted | 2 studies · 431 participants | Low |
Should short (fixed duration)‐course antibiotic therapy versus prolonged‐course antibiotic therapy be used for critically ill patients with hospital‐acquired pneumonia?
Population: critically ill patients with hospital‐acquired pneumonia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
28‐day mortality Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.08 [0.66, 1.76] | 2 studies · 431 participants | Ungraded |
28‐day mortality ‐ NF‐GNB Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 0.71 [0.32, 1.56] | 1 study · 127 participants | Ungraded |
28‐day mortality ‐ MRSA Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.28 [0.32, 5.09] | 1 study · 42 participants | Ungraded |
Recurrence of pneumonia Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.37 [0.87, 2.17] | 3 studies · 508 participants | Ungraded |
Recurrence of pneumonia ‐ NF‐GNB Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 2.18 [1.14, 4.16] | 2 studies · 176 participants | Ungraded |
Recurrence of pneumonia ‐ MRSA Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | OR 1.56 [0.12, 19.61] | 2 studies · 49 participants | Ungraded |
28‐day antibiotic‐free days Should short (fixed duration)‐course antibiotic therapy vs prolonged‐course antibiotic therapy be used | no estimate extracted | 2 studies · 431 participants | Ungraded |
Discontinuation of antibiotics according to Clinical Pulmonary Infection Score for critically ill adults with hospital‐acquired pneumonia
Population: critically ill adults with hospital‐acquired pneumonia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
30‐day mortality | OR 0.33 [0.1, 1.03] | 1 study · 81 participants | Ungraded |
Episodes of superinfection or antimicrobial resistance | OR 0.29 [0.09, 0.92] | 1 study · 81 participants | Ungraded |
Duration of antibiotic therapy | no estimate extracted | 1 study · 81 participants | Ungraded |
Duration of ITU stay | no estimate extracted | 1 study · 81 participants | Ungraded |
Discontinuation of antibiotics according to clinical guideline for hospital‐acquired pneumonia in critically ill adults
Population: patients with hospital‐acquired pneumonia in critically ill adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence of pneumonia | OR 0.88 [0.48, 1.59] | 1 study · 290 participants | Ungraded |
Duration of antibiotic therapy | no estimate extracted | 1 study · 290 participants | Ungraded |
In‐hospital mortality | OR 0.8 [0.49, 1.29] | 1 study · 290 participants | Ungraded |
Duration of ICU stay | no estimate extracted | 1 study · 290 participants | Ungraded |
Duration of hospital stay | no estimate extracted | 1 study · 290 participants | Ungraded |
Duration of mechanical ventilation | no estimate extracted | 1 study · 290 participants | Ungraded |
Discontinuation of antibiotic therapy according to serum procalcitonin level for hospital‐acquired pneumonia in critically ill adults
Population: hospital‐acquired pneumonia in critically ill adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
28‐day mortality | OR 0.66 [0.39, 1.14] | 3 studies · 308 participants | Ungraded |
Recurrence of pneumonia | OR 2.06 [0.74, 5.7] | 1 study · 66 participants | Ungraded |
28‐day antibiotic‐free days | no estimate extracted | 2 studies · 167 participants | Ungraded |
Duration of antibiotic therapy days | no estimate extracted | 3 studies · 308 participants | Ungraded |