Duration of antimicrobial therapy for nosocomial pneumonia: possible strategies for minimizing antimicrobial use in intensive care units

Objective: To review published data evaluating shorter courses of antibiotic therapy for nosocomial pneumonia and provide recommendations for minimizing antimicrobial use in intensive care units. Data source: Literature was identified through MEDLINE (1966 through 6/2002) and a manual search of critical care, infectious disease, and pharmacy journals was conducted to identify relevant abstracts. Data synthesis: Antibiotic use may be decreased by discontinuing therapy after 3 days in patients with low likelihood of nosocomial pneumonia. In addition, clinical guidelines or invasive diagnostic procedures may be effectively instituted to reduce duration of antibiotic therapy. Conclusion: Shorter-course antibiotic therapy may be beneficial in decreasing lengths of hospital and intensive care units stays, antimicrobial resistance, and total hospital costs. Further research is needed to determine the optimal duration of therapy in patients with nosocomial pneumonia.