Is the “8 day rule” for treatment of healthcare-associated pneumonia (HCAP) appropriate irrespective of etiologic agent?

Not necessarily.  In fact, the original study showed more relapses among patients with Pseudomonas aeruginosa nosocomial pneumonia treated for 8 days compared to 15 days, and concluded that the results did not apply to “non-fermenting gram negative bacilli” (1). For methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, the data on the effectiveness of the shorter course therapy is quite limited (1,2) .  So for patients with pneumonia due to organisms such as P. aeruginosa or MRSA I routinely extend the course of antibiotics to at least 2 weeks.

1. Chastre J, Wolff M, Fagon JY. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290:2588-98. 

2. Rubinstein E, Kollef MH, Nathwani D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2008;46 (Suppl5):S378-385.

Is the “8 day rule” for treatment of healthcare-associated pneumonia (HCAP) appropriate irrespective of etiologic agent?

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