• Huzaifa Ahmad Cheema, Aayat Ellahi, Hassan Ul Hussain, Haider Kashif, Mariam Adil, Danisha Kumar, Abia Shahid, Muhammad Ehsan, Harpreet Singh, Natalie Duric, and Tamas Szakmany.
• Department of Chest Medicine, King Edward Medical University, Lahore, Pakistan. Electronic address: huzaifaahmadcheema@gmail.com.
• J Crit Care. 2023 Dec 1; 78: 154346154346.

BackgroundCurrent guidelines recommend short-duration antibiotic therapy for non-fermenting gram-negative bacilli (NF-GNB) ventilator-associated pneumonia (VAP) which may be associated with a higher recurrence of pneumonia. In this meta-analysis, we aimed to compare short- versus prolonged-course antibiotic regimens for VAP.MethodsWe searched several databases for randomized controlled trials (RCTs) that compared the effectiveness of a short- versus long-course of antibiotic treatment in patients with VAP. Data analysis was performed using RevMan 5.4.ResultsOur pooled analysis consisted of six RCTs. For 28-day mortality, no significant difference was found between the prolonged course and the short course. Administration of a short course of antibiotics increased the risk of recurrence of pneumonia in patients with VAP due to NF-GNB (RR 1.73; 95% CI: 1.17-2.54). Secondary outcomes, such as clinical resolution, duration of ICU stay, and duration of mechanical ventilation, revealed no significant difference between the two regimens. The quality of evidence was low for most outcomes.ConclusionsLow-quality evidence suggests that a short course of antibiotics is associated with a higher recurrence of pneumonia in NF-GNB VAP with no difference in mortality as compared to a prolonged course. For definitive conclusions, large-scale and blinded RCTs are required.Copyright © 2023 Elsevier Inc. All rights reserved.

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