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To which extent can we decrease antibiotic duration in critically ill patients?

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Abstract
Introduction: Inadequate empirical antibiotic therapy is associated with higher mortality in critically ill patients with severe infections. Nevertheless, prolonged duration of antibiotic treatment is also potentially harmful. Development of new infections with more resistant pathogens is one of the arguments against the administration of prolonged courses of antibiotics. Areas covered: We aim to describe the optimal duration of antimicrobial therapy in the most common infections affecting critically ill patients. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed. Expert commentary: Diverse observational studies have reported a poor outcome in critically ill patients without a documented infection who receive prolonged antibiotic therapy. We summarize the available information about the optimal duration of antimicrobial therapy in critically ill patients with severe infections including community-acquired pneumonia, intra-abdominal infections, bacteremia, meningitis and urinary-tract infections as well as the clinical consequences of short antimicrobial courses in certain severe infections. The utility of procalcitonin to reduce the duration of antibiotics is also discussed. Finally, we give clear recommendations about the length of treatment for the most common infections in critically ill patients.
Keywords
Critically ill patient, antimicrobial therapy, pneumonia, ventilator-associated pneumonia, procalcitonin, Candidemia, VENTILATOR-ASSOCIATED PNEUMONIA, INTENSIVE-CARE-UNIT, COMMUNITY-ACQUIRED PNEUMONIA, STAPHYLOCOCCUS-AUREUS BACTEREMIA, INFECTIOUS-DISEASES-SOCIETY, RANDOMIZED CONTROLLED-TRIAL, RESPIRATORY-TRACT INFECTIONS, PROCALCITONIN-GUIDED THERAPY, SEVERE SEPSIS, SEPTIC SHOCK

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Please use this url to cite or link to this publication:

Chicago
Garnacho-Montero, José, Angel Arenzana-Seisdedos, Jan De Waele, and Marin H Kollef. 2017. “To Which Extent Can We Decrease Antibiotic Duration in Critically Ill Patients?” Expert Review of Clinical Pharmacology 10 (11): 1215–1223.
APA
Garnacho-Montero, J., Arenzana-Seisdedos, A., De Waele, J., & Kollef, M. H. (2017). To which extent can we decrease antibiotic duration in critically ill patients? EXPERT REVIEW OF CLINICAL PHARMACOLOGY, 10(11), 1215–1223.
Vancouver
1.
Garnacho-Montero J, Arenzana-Seisdedos A, De Waele J, Kollef MH. To which extent can we decrease antibiotic duration in critically ill patients? EXPERT REVIEW OF CLINICAL PHARMACOLOGY. 2017;10(11):1215–23.
MLA
Garnacho-Montero, José, Angel Arenzana-Seisdedos, Jan De Waele, et al. “To Which Extent Can We Decrease Antibiotic Duration in Critically Ill Patients?” EXPERT REVIEW OF CLINICAL PHARMACOLOGY 10.11 (2017): 1215–1223. Print.
@article{8536056,
  abstract     = {Introduction: Inadequate empirical antibiotic therapy is associated with higher mortality in critically ill patients with severe infections. Nevertheless, prolonged duration of antibiotic treatment is also potentially harmful. Development of new infections with more resistant pathogens is one of the arguments against the administration of prolonged courses of antibiotics. 
Areas covered: We aim to describe the optimal duration of antimicrobial therapy in the most common infections affecting critically ill patients. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed. 
Expert commentary: Diverse observational studies have reported a poor outcome in critically ill patients without a documented infection who receive prolonged antibiotic therapy. We summarize the available information about the optimal duration of antimicrobial therapy in critically ill patients with severe infections including community-acquired pneumonia, intra-abdominal infections, bacteremia, meningitis and urinary-tract infections as well as the clinical consequences of short antimicrobial courses in certain severe infections. The utility of procalcitonin to reduce the duration of antibiotics is also discussed. Finally, we give clear recommendations about the length of treatment for the most common infections in critically ill patients.},
  author       = {Garnacho-Montero, Jos{\'e} and Arenzana-Seisdedos, Angel and De Waele, Jan and Kollef, Marin H},
  issn         = {1751-2433},
  journal      = {EXPERT REVIEW OF CLINICAL PHARMACOLOGY},
  keyword      = {Critically ill patient,antimicrobial therapy,pneumonia,ventilator-associated pneumonia,procalcitonin,Candidemia,VENTILATOR-ASSOCIATED PNEUMONIA,INTENSIVE-CARE-UNIT,COMMUNITY-ACQUIRED PNEUMONIA,STAPHYLOCOCCUS-AUREUS BACTEREMIA,INFECTIOUS-DISEASES-SOCIETY,RANDOMIZED CONTROLLED-TRIAL,RESPIRATORY-TRACT INFECTIONS,PROCALCITONIN-GUIDED THERAPY,SEVERE SEPSIS,SEPTIC SHOCK},
  language     = {eng},
  number       = {11},
  pages        = {1215--1223},
  title        = {To which extent can we decrease antibiotic duration in critically ill patients?},
  url          = {http://dx.doi.org/10.1080/17512433.2017.1369879},
  volume       = {10},
  year         = {2017},
}

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