Choosing an antibiotic for Vincent

In this video Dr Lilian Abbo discusses the antibiotic treatment options for Vincent.

Please note, the final slide of the video should read ceftazanine/avibactam, rather than cefepime/avibactam.

Please watch the video and then consider the duration of therapy for Vincent:

• 3 days
• 5 days
• 8 days
• 14 days
• 21 days

There are no standardised studies on the duration of treatment for VAP for carbapenem resistant pseudomonas, but clinically we extrapolate from studies with more susceptible bacteria.

An article by Chastre:

provides this data:

• Same probability of survival after 60 days

• Mortality: 18.8 vs. 17.2% at 28 days

• Relapse: 29% vs. 26% (higher with non-fermenting gram negative bacteria 41% vs. 25%)

• In the short length arm there was a lower risk of multi drug resistant bacteria 42% vs. 61% in patients treated with longer course of antibiotics on the first episode.

• In most cases 8 days is effective to treat VAP. Less is more.

You may also like to read Brad Spellberg’s paper “The New Antibiotic Mantra: – “Shorter the better”, 2016 which discusses the evidence for the duration of antibiotic therapy.