Shorter, smarter, safer: Short-course antibiotics prove effective against ventilator-associated pneumonia

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Antibiotic overuse is a key driver in the rise of antimicrobial resistance (AMR), a major global health crisis. Researchers from the Yong Loo Lin School of Medicine, NUS (NUS Medicine) and Duke-NUS Medical School have provided compelling evidence that short-course antibiotic treatments can be a game-changer in tackling ventilator-associated pneumonia (VAP), a serious infection common in critically ill patients.

The findings from the landmark REGARD-VAP trial, published in Lancet Respiratory Medicine, and the accompanying economic analyses published in The Lancet Global Health, highlight how prudent antibiotic use can curb resistance, effectively safeguarding patients as well as combating the global threat of antimicrobial resistance while reducing health care costs.

Led by the NUS Medicine research team, the clinical trial examined more than 450 patients across intensive care units (ICUs) in Singapore, Thailand, and Nepal. Results revealed that short-course antibiotics—carefully tailored to individual patients’ recovery—are just as effective as traditional longer treatments in preventing death and recurrence of pneumonia.

“By shortening the duration of antibiotics, we can reduce the risks of side effects and resistance without compromising patient outcomes,” added Dr. Mo Yin, Junior Academic Fellow at the Department of Medicine, NUS Medicine, and principal investigator of the clinical trial, and co-author of the economic analysis.

The economic analyses, led by the Duke-NUS research team, accompanying the trial were just published in The Lancet Global Health. They demonstrated that adopting short-course antibiotics offers significant value for health care systems.

Shorter, smarter, safer: Short-course antibiotics can revolutionize health care
Cost-effectiveness acceptability curves The dashed lines represent the likelihood of cost-effectiveness at each country’s willingness to-pay-threshold, in Nepal (A), Singapore (B), and Thailand (C). Credit: The Lancet Global Health (2024). DOI: 10.1016/S2214-109X(24)00327-9

In Singapore, the strategy is cost-saving, reducing hospital expenditure while maintaining excellent outcomes for patients. In Thailand and Nepal, short-course antibiotics were highly cost-effective, with health gains outweighing the modest additional costs incurred.

“Short-course antibiotics are a pragmatic solution that benefits patients and health care systems alike, particularly in resource-limited settings,” said Assistant Professor Yiying Cai, lead researcher from the Health Services and Systems Research Program at Duke-NUS.

The REGARD-VAP study’s findings have practical implications for hospitals worldwide. Short-course antibiotics can streamline treatment in ICUs, where managing infections efficiently is vital. The approach is effective across high-income (Singapore), middle-income (Thailand), and low-income (Nepal) settings, making it a scalable solution for diverse health care systems. These results provide robust evidence, including cost-effectiveness data for policymakers to adopt short-course antibiotics into national and institutional guidelines.

The team hopes to disseminate their findings globally to encourage the adoption of short-course antibiotics, particularly in regions with limited resources. They also advocate for integrating cost-effectiveness studies into future clinical trials to strengthen both clinical and economic decision-making processes.

By reducing unnecessary antibiotic exposure, short-course treatments help preserve the effectiveness of existing drugs for future generations. Every additional day of antibiotic use increases the risk of drug resistance by 7%. Reducing treatment duration is a critical step in combating this silent epidemic.

“Prudent antibiotic use is essential to combat antimicrobial resistance and optimize health care outcomes. Our findings make a strong case for adopting short-course antibiotics as the new standard of care,” concluded Dr. Mo Yin.

More information:
Yiying Cai et al, Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial, The Lancet Global Health (2024). DOI: 10.1016/S2214-109X(24)00327-9

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Shorter, smarter, safer: Short-course antibiotics prove effective against ventilator-associated pneumonia (2025, January 21)
retrieved 21 January 2025
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