Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Grupsagessa     Gmail     Yahoo Mail     Dropbox     Instagram     Slack     Google Drive     Print     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


Mi foto
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com


iEM Education Project in 12 Questions (https://iem-student.org/)

Buscar en contenido


martes, 30 de agosto de 2016

Double-coverage for VAP

PulmCrit (EMCrit)
PulmCrit - August 29, 2016 - By Josh Farkas 
  • "Prospective RCTs have not shown a benefit from double-coverage.
  • In order for double-coverage to be beneficial, a chain of events must occur. The patient must truly have VAP, that VAP must be due to a gram-negative, the gram negative must be resistant to the beta-lactam, the gram negative must be sensitive to the second antibiotic, and broader antibiotic coverage must make a clinical difference. The likelihood of this entire sequence of events occurring is about 1-2%.
  • Double-coverage with a fluoroquinolone is difficult to justify given rising resistance to fluoroquinolones and a significant toxicity profile.
  • Double-coverage with an aminoglycoside may be considered in specific patients, but in most cases nephrotoxicity outweighs benefit.
  • Monotherapy with an optimal beta-lactam may be more effective than double-coverage with a suboptimal beta-lactam. More isn’t necessarily better.
  • The IDSA recommendation utilize double-coverage in nearly all patients with VAP is not evidence-based."