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Choosing an antibiotic for Vincent

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

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

  1. 3 days
  2. 5 days
  3. 8 days
  4. 14 days
  5. 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:

 Graph with x axis "Probability of survival 0 - 1.0, y axis "Days after bronchoscopy" 0 -60.  Two tracked lines of data representing antibiotic regimen of 8 days or 15 days.  Data shows slightly better survival with 8 day regimen

provides this data:

Alt text

  • 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.

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This video is from the free online course:

Challenges in Antibiotic Resistance: Gram Negative Bacteria

BSAC

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