Durée de l'antibiothérapie des infections sévères en réanimation

A high number of controlled studies have shown that early and adequate antimicrobial treatment significantly improves the prognosis of severe infections in critically ill patients. In contrast, few well-designed trials have evaluated the optimal duration of antibiotic therapy. Consequently, current recommendations regarding this question are based primarily on clinical experience and expert opinions. In most cases, the number of organisms is significantly reduced within 24 hours provided that: antibiotics are appropriate, the patient is immunocompetent, the source of infection is controlled and there is no foreign material. In the majority of patients, a long duration (> 8 days) is not justified and may contribute to increase the selection pressure for resistance. A recent prospective, randomised trial has shown that 8 days of adequate antibiotic therapy is an adequate duration for ventilator-associated pneumonia. Future trials will probably compare predefined different duration or discontinuation policies based on clinical response and evolution of biological markers.