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Duration of pneumonia therapy and the role of biomarkers

Kaziani, Katerina; Sotiriou, Adamantia; Dimopoulos, George

Current Opinion in Infectious Diseases: April 2017 - Volume 30 - Issue 2 - p 221–225
doi: 10.1097/QCO.0000000000000351
RESPIRATORY INFECTIONS: Edited by Michael S. Niederman
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Purpose of review: Increasing antimicrobial resistance is a worldwide phenomenon that is threatening public health. Lower respiratory infections are one of the leading causes of morbidity that contribute to antibiotic consumption and thus the emergence of multidrug-resistant microbial strains. The goal of shortening antibiotic regimens’ duration in common bacterial infections has been prioritized by antimicrobial stewardship programs as an action against this problem.

Recent findings: Data coming from randomized controlled trials, meta-analyses, and systematic reviews support the shortening of antimicrobial regimens in community-acquired, hospital-acquired, and ventilator-associated pneumonia. Short schedules have been proven at least as effective as long ones in terms of antimicrobial-free days and clinical cure. Procalcitonin-based algorithms have been validated as well tolerated and cost-effective tools for the duration of pneumonia therapy reduction.

Summary: Shortening the duration of antibiotic regimens in pneumonia seems a reasonable strategy for reducing selective pressure driving antimicrobial resistance and costs provided that clinical cure is guaranteed. Procalcitonin-based protocols have been proven essentially helpful in this direction.

Video abstract: http://links.lww.com/COID/A17

a3rd Department of Internal Medicine, Sotiria General Hospital

b1st Department of Critical Care Medicine, Evangelismos General Hospital

c2nd Department of Critical Care Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University, Athens, Greece

Correspondence to Professor George Dimopoulos, MD, PhD, 2nd Department of Critical Care Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University, 1 Rimini st, Haidari, Athens 12462, Greece. Tel: +306944756565; fax: +302105832182; e-mail: gdimop@med.uoa.gr

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