Should antibiotic combinations be used to treat ventilator-associated pneumonia?

Seminars in Respiratory and Critical Care Medicine
Philippe Eggimann, Jean-Pierre Revelly

Abstract

This review summarizes the rationale for using or not using combinations of antibiotics to treat ventilator-associated pneumonia (VAP). Patients suffering from VAP require empirical antibiotic treatment before the identification of an etiologic agent. Most treatment failures are related to inappropriate initial antibiotic treatment with insufficient coverage of multidrug-resistant (MDR) pathogens. Guidelines require initial (empirical) treatment of VAP with a combination of antibiotics. However, this contributes to overexposure to antibiotics and further emergence of MDR microorganisms. We review the rationale for using combinations of antibiotics to cover MDR gram-negatives. However, clinical data supporting this strategy are limited. In fact, systematic combination therapy may have contributed to the overuse of antibiotics and to the emergence of MDR microorganisms. Nevertheless, combination therapy is our best strategy to treat severe infections due to suspected MDR microorganisms. Optimally, therapeutic strategies should be sufficiently broad to cover relevant pathogens while minimizing the risk for emergence of antimicrobial resistance.

Citations

Jan 25, 2013·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·C PeñaJ Ariza
Sep 10, 2008·Proceedings of the National Academy of Sciences of the United States of America·Matthew HegrenessRoy Kishony
Apr 13, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Carmen PeñaUNKNOWN Spanish Network for Research in Infectious Diseases (REIPI)
Jun 10, 2008·International Journal of Antimicrobial Agents·Kyriaki KanellakopoulouEvangelos J Giamarellos-Bourboulis
Feb 3, 2007·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·N MesarosF Van Bambeke

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