Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review
Dimitra Dimopoulou,
Charalampos D. Moschopoulos,
Konstantina Dimopoulou,
Anastasia Dimopoulou,
Maria M. Berikopoulou,
Ilias Andrianakis,
Sotirios Tsiodras,
Anastasia Kotanidou,
Paraskevi C. Fragkou
Affiliations
Dimitra Dimopoulou
Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
Charalampos D. Moschopoulos
Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
Konstantina Dimopoulou
Department of Gastroenterology, Red Cross Hospital of Athens, 11526 Athens, Greece
Anastasia Dimopoulou
Department of Pediatric Surgery, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
Maria M. Berikopoulou
Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
Ilias Andrianakis
Department of Intensive Care Unit, Hygeia Hospital, 15123 Athens, Greece
Sotirios Tsiodras
Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
Anastasia Kotanidou
First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
Paraskevi C. Fragkou
First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
Pneumonia remains a major global health concern, causing significant morbidity and mortality among adults. This narrative review assesses the optimal duration of antimicrobial treatment in adults with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Current evidence about the impact of treatment duration on clinical outcomes demonstrates that shorter antibiotic courses are non-inferior, regarding safety and efficacy, compared to longer courses, particularly in patients with mild to moderate CAP, which is in line with the recommendations of international guidelines. Data are limited regarding the optimal antimicrobial duration in HAP patients, and it should be individually tailored to each patient, taking into account the causative pathogen and the clinical response. Shorter courses are found to be as effective as longer courses in the management of VAP, except for pneumonia caused by non-fermenting Gram-negative bacteria; however, duration should be balanced between the possibility of higher recurrence rates and the documented benefits with shorter courses. Additionally, the validation of reliable biomarkers or clinical predictors that identify patients who would benefit from shorter therapy is crucial. Insights from this review may lead to future research on personalized antimicrobial therapies in pneumonia, in order to improve patient outcomes.
