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Review of antibiotics therapy in ventilator associated pneumonia
Abstract
Abstract. A significant cause of morbidity and mortality was ranked as ventilator associated pneumonia (VAP). Therefore studies based on evidence-based pharmacotherapy could help in preventing multiple drug resistance and microorganism colonization. Experts suggested an 8 or 14-21 days course of vigilant antibiotics. Therefore, to reduce toxicity and cost, this systematic review aims to investigate updated antibiotic regimens for VAP. Web of Science, PubMed and Google Scholar were searched. New-onset pneumonia that developing more than 48 hours after endotracheal intubation was defined as VAP. Regarding pulmonary recurrent or excess mortality an 8 days course antibiotic therapy showed appropriate. For treatment of resistant pathogens with high minimum inhibitory concentrations, aerosolized antimicrobilas suggested more effective. Monitoring fever, prolcalcitonin values, C-reactive protein and PaO2/FiO(2) should also be considered. In addition report indicated that serum prolcalcitonin reduces the exposure of antibiotics. A study of 100 VAP patients reported that mortality rates were significantly associated with a change in antibiotic therapy. Published result associated with 12 studies included 3571 patients with VAP, confirmed no statistical difference in all‐cause mortality between monotherapy and combination therapy, clinical cure, length of stay in ICU or adverse events. Studies comparing tigecycline versus imipenem‐cilastatin for clinical cure in the clinically evaluable population showed statistically significant increase in clinical cure for imipenem‐cilastatin. There was no statistical difference in all‐cause mortality between carbapenem and non‐carbapenem therapies or adverse events, but carbapenems were associated with a statistically significant increase in the clinical cure. Treatment strategy in VAP should be considered based on pathogen reports. Vigilant attention to patient clinical status recommended to be advantageous for considering limited spectrum antibiotics.
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