Rein in Antibiotic Resistance

Breathing tube infections require only short-term course of antibiotics

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Kids on ventilators often develop infections because the breathing tubes provide an easy route for bacteria to get stuck in the respiratory tract.

In order to evaluate whether longer courses of antibiotics were more valuable to kids using breathing tubes, Johns Hopkins investigators analyzed three years of medical records including kids 18 years or younger who spent at least two days on a ventilator.

These children often need antibiotics to fight an infection from spreading into the lungs, but the optimal length of treatment has been unclear. Longer courses of antibiotic use were no more effective than short courses of antibiotics in reducing infections in these children.

"Ask your doctors why you are taking antibiotics."

Lead investigator Pranita Tamma, M. D., an infectious disease specialist at the Johns Hopkins Children's Center illuminates that their  study underscores the old physician maxim to first and most importantly do no harm.

Longer treatment is not always more effective. In addition to that, it can be downright dangerous. Children who received the lengthy antibiotic course were five times more likely, on average, to develop drug-resistant infections following the treatment. Children who got multiple antibiotics were three times as likely to do so.

Tamma continues that  the  hope of our findings is to clear up some of the confusion and discourage physicians from preemptively opting for longer treatments.

Although the length of antibiotic use made no statistical difference in pneumonia risk, the length of intubation did. Children whose tubes were left in after diagnosis of infection and start of therapy were four times more likely to progress to pneumonia than children taken off the ventilator promptly after diagnosis and start of treatment.

The Study

  • Medical records of more than 1,600 children, age 18 and younger, who spent at least two days on a breathing tube
  • 150 got antibiotics for ventilator-related upper respiratory infections; only 118 of them, however, met clinical criteria for such infections, and 32 were treated merely on a physician hunch of infection
  • The finding emphasizes the need for careful daily reassessment of each child's need to stay on a ventilator
  • Of the 82 children with actual infections who were treated with antibiotics for more than a week, 23 percent developed pneumonia, compared to 20 percent of the 36 children who got antibiotics for seven days or fewer
Reviewed by: 
Review Date: 
May 7, 2011
Last Updated:
May 26, 2011