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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 1 28‐day mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 1 28‐day mortality.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 2 Recurrence of pneumonia.
Figures and Tables -
Analysis 1.2

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 2 Recurrence of pneumonia.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 3 28‐day antibiotic‐free days.
Figures and Tables -
Analysis 1.3

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 3 28‐day antibiotic‐free days.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 4 ITU mortality.
Figures and Tables -
Analysis 1.4

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 4 ITU mortality.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 5 Non‐resolution of pneumonia.
Figures and Tables -
Analysis 1.5

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 5 Non‐resolution of pneumonia.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 6 In‐hospital mortality.
Figures and Tables -
Analysis 1.6

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 6 In‐hospital mortality.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 7 Recurrence due to multi‐resistant organism.
Figures and Tables -
Analysis 1.7

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 7 Recurrence due to multi‐resistant organism.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 8 Duration of ITU stay.
Figures and Tables -
Analysis 1.8

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 8 Duration of ITU stay.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 9 Duration of hospital stay.
Figures and Tables -
Analysis 1.9

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 9 Duration of hospital stay.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 10 Duration of mechanical ventilation.
Figures and Tables -
Analysis 1.10

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 10 Duration of mechanical ventilation.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 11 28‐day mechanical ventilation‐free days.
Figures and Tables -
Analysis 1.11

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 11 28‐day mechanical ventilation‐free days.

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 12 Mortality associated with VAP.
Figures and Tables -
Analysis 1.12

Comparison 1 Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP, Outcome 12 Mortality associated with VAP.

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 1 30‐day mortality.
Figures and Tables -
Analysis 2.1

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 1 30‐day mortality.

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 2 Episodes of superinfection or antimicrobial resistance.
Figures and Tables -
Analysis 2.2

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 2 Episodes of superinfection or antimicrobial resistance.

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 3 Duration of antibiotic therapy.
Figures and Tables -
Analysis 2.3

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 3 Duration of antibiotic therapy.

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 4 Duration of ITU stay.
Figures and Tables -
Analysis 2.4

Comparison 2 Discontinuation of antibiotics according to Clinical Pulmonary Infection Score, Outcome 4 Duration of ITU stay.

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 1 Recurrence of pneumonia.
Figures and Tables -
Analysis 3.1

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 1 Recurrence of pneumonia.

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 2 Duration of antibiotic therapy.
Figures and Tables -
Analysis 3.2

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 2 Duration of antibiotic therapy.

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 3 In‐hospital mortality.
Figures and Tables -
Analysis 3.3

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 3 In‐hospital mortality.

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 4 Duration of ITU stay.
Figures and Tables -
Analysis 3.4

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 4 Duration of ITU stay.

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 5 Duration of hospital stay.
Figures and Tables -
Analysis 3.5

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 5 Duration of hospital stay.

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 6 Duration of mechanical ventilation.
Figures and Tables -
Analysis 3.6

Comparison 3 Discontinuation of antibiotics according clinical guideline, Outcome 6 Duration of mechanical ventilation.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 1 28‐day mortality.
Figures and Tables -
Analysis 4.1

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 1 28‐day mortality.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 2 Recurrence of pneumonia.
Figures and Tables -
Analysis 4.2

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 2 Recurrence of pneumonia.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 3 28‐day antibiotic‐free days.
Figures and Tables -
Analysis 4.3

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 3 28‐day antibiotic‐free days.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 4 Duration of antibiotic therapy.
Figures and Tables -
Analysis 4.4

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 4 Duration of antibiotic therapy.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 5 In‐hospital mortality.
Figures and Tables -
Analysis 4.5

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 5 In‐hospital mortality.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 6 ITU mortality.
Figures and Tables -
Analysis 4.6

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 6 ITU mortality.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 7 Non‐resolution of pneumonia.
Figures and Tables -
Analysis 4.7

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 7 Non‐resolution of pneumonia.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 8 Recurrence due to resistant organism.
Figures and Tables -
Analysis 4.8

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 8 Recurrence due to resistant organism.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 9 ITU duration of stay.
Figures and Tables -
Analysis 4.9

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 9 ITU duration of stay.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 10 Duration of hospital stay.
Figures and Tables -
Analysis 4.10

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 10 Duration of hospital stay.

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 11 Duration of mechanical ventilation.
Figures and Tables -
Analysis 4.11

Comparison 4 Discontinuation of antibiotic therapy according to serum procalcitonin level, Outcome 11 Duration of mechanical ventilation.

Summary of findings for the main comparison. Should short (fixed duration)‐course antibiotic therapy versus prolonged‐course antibiotic therapy be used for critically ill patients with hospital‐acquired pneumonia?

Should short (fixed duration)‐course antibiotic therapy versus prolonged‐course antibiotic therapy be used for critically ill patients with hospital‐acquired pneumonia?

Patient or population: critically ill patients with hospital‐acquired pneumonia
Settings: ICU
Intervention: short (fixed duration)‐course antibiotic therapy
Comparison: prolonged course antibiotic therapy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Prolonged‐course antibiotic therapy

Short (fixed duration)‐course antibiotic therapy

28‐day mortality

Study population

OR 1.08
(0.66 to 1.76)

431
(2 studies)

186 per 1000

198 per 1000
(131 to 287)

Medium‐risk population

270 per 1000

285 per 1000
(196 to 394)

28‐day mortality ‐ NF‐GNB

Study population

OR 0.71
(0.32 to 1.56)

127
(1 study)

See comment

302 per 1000

235 per 1000
(122 to 403)

Medium‐risk population

302 per 1000

235 per 1000
(122 to 403)

28‐day mortality ‐ MRSA

Study population

OR 1.28
(0.32 to 5.09)

42
(1 study)

See comment

238 per 1000

286 per 1000
(91 to 614)

Medium‐risk population

238 per 1000

286 per 1000
(91 to 614)

Recurrence of pneumonia

Study population

OR 1.37
(0.87 to 2.17)

508
(3 studies)

245 per 1000

308 per 1000
(220 to 413)

Medium‐risk population

227 per 1000

287 per 1000
(203 to 389)

Recurrence of pneumonia ‐ NF‐GNB

Study population

OR 2.18
(1.14 to 4.16)

176
(2 studies)

247 per 1000

417 per 1000
(272 to 577)

Medium‐risk population

241 per 1000

409 per 1000
(266 to 569)

Recurrence of pneumonia ‐ MRSA

Study population

OR 1.56
(0.12 to 19.61)

49
(2 studies)

370 per 1000

478 per 1000
(66 to 920)

Medium‐risk population

298 per 1000

398 per 1000
(48 to 893)

28‐day antibiotic‐free days

The mean 28‐day antibiotic‐free days in the intervention groups was
4.02 higher
(2.26 to 5.78 higher)

431
(2 studies)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; MRSA: methicillin‐resistant Staphylococcus aureus; NF‐GNB: non‐fermenting Gram‐negative bacilli; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Summary of findings for the main comparison. Should short (fixed duration)‐course antibiotic therapy versus prolonged‐course antibiotic therapy be used for critically ill patients with hospital‐acquired pneumonia?
Summary of findings 2. Discontinuation of antibiotics according to Clinical Pulmonary Infection Score for critically ill adults with hospital‐acquired pneumonia

Discontinuation of antibiotics according to Clinical Pulmonary Infection Score for critically ill adults with hospital‐acquired pneumonia

Patient or population: critically ill adults with hospital‐acquired pneumonia
Settings: ICU
Intervention: discontinuation of antibiotics according to Clinical Pulmonary Infection Score

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Discontinuation of antibiotics according to Clinical Pulmonary Infection Score

30‐day mortality

Study population

OR 0.33
(0.1 to 1.03)

81
(1 study)

See comment

310 per 1000

129 per 1000
(43 to 316)

Medium‐risk population

310 per 1000

129 per 1000
(43 to 316)

Episodes of superinfection or antimicrobial resistance

Study population

OR 0.29
(0.09 to 0.92)

81
(1 study)

See comment

333 per 1000

126 per 1000
(43 to 315)

Medium‐risk population

333 per 1000

126 per 1000
(43 to 315)

Duration of antibiotic therapy

See comment

See comment

Not estimable

81
(1 study)

See comment

Duration of ITU stay

See comment

See comment

Not estimable

81
(1 study)

See comment

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; ITU: intensive therapy unit; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Summary of findings 2. Discontinuation of antibiotics according to Clinical Pulmonary Infection Score for critically ill adults with hospital‐acquired pneumonia
Summary of findings 3. Discontinuation of antibiotics according to clinical guideline for hospital‐acquired pneumonia in critically ill adults

Discontinuation of antibiotics according to clinical guideline for hospital‐acquired pneumonia in critically ill adults

Patient or population: patients with hospital‐acquired pneumonia in critically ill adults
Settings: ICU
Intervention: discontinuation of antibiotics according to clinical guideline

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Discontinuation of antibiotics according to clinical guideline

Recurrence of pneumonia

Study population

OR 0.88
(0.48 to 1.59)

290
(1)

See comment

193 per 1000

174 per 1000
(103 to 275)

Medium‐risk population

193 per 1000

174 per 1000
(103 to 275)

Duration of antibiotic therapy

The mean duration of antibiotic therapy in the intervention groups was
2 lower
(3.21 to 0.79 lower)

290
(1)

See comment

In‐hospital mortality

Study population

OR 0.8
(0.49 to 1.29)

290
(1)

See comment

371 per 1000

321 per 1000
(224 to 432)

Medium‐risk population

371 per 1000

321 per 1000
(224 to 432)

Duration of ICU stay

The mean duration of ICU stay in the intervention groups was
0.2 lower
(1.75 lower to 1.35 higher)

290
(1)

See comment

Duration of hospital stay

The mean duration of hospital stay in the intervention groups was
0.3 higher
(3.63 lower to 4.23 higher)

290
(1)

See comment

Duration of mechanical ventilation

The mean duration of mechanical ventilation in the intervention groups was
0.3 lower
(1.79 lower to 1.19 higher)

290
(1)

See comment

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; ICU: intensive care unit; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Summary of findings 3. Discontinuation of antibiotics according to clinical guideline for hospital‐acquired pneumonia in critically ill adults
Summary of findings 4. Discontinuation of antibiotic therapy according to serum procalcitonin level for hospital‐acquired pneumonia in critically ill adults

Discontinuation of antibiotic therapy according to serum procalcitonin level for hospital‐acquired pneumonia in critically ill adults

Patient or population: hospital‐acquired pneumonia in critically ill adults
Settings: ICU
Intervention: discontinuation of antibiotic therapy according to serum procalcitonin level

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Discontinuation of antibiotic therapy according to serum procalcitonin level

28‐day mortality

Study population

OR 0.66
(0.39 to 1.14)

308
(3 studies)

265 per 1000

192 per 1000
(123 to 291)

Medium‐risk population

258 per 1000

187 per 1000
(119 to 284)

Recurrence of pneumonia

Study population

OR 2.06
(0.74 to 5.7)

66
(1 study)

See comment

286 per 1000

452 per 1000
(229 to 695)

Medium‐risk population

286 per 1000

452 per 1000
(229 to 695)

28‐day antibiotic‐free days

The mean 28‐day antibiotic‐free days in the intervention groups was
2.8 higher
(1.39 to 4.21 higher)

167
(2 studies)

Duration of antibiotic therapy
days

The mean duration of antibiotic therapy in the intervention groups was
3.2 lower
(4.45 to 1.95 lower)

308
(3 studies)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; ICU: intensive care unit; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Summary of findings 4. Discontinuation of antibiotic therapy according to serum procalcitonin level for hospital‐acquired pneumonia in critically ill adults
Comparison 1. Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 28‐day mortality Show forest plot

2

431

Odds Ratio (M‐H, Random, 95% CI)

1.08 [0.66, 1.76]

1.1 NF‐GNB

1

127

Odds Ratio (M‐H, Random, 95% CI)

0.71 [0.32, 1.56]

1.2 MRSA

1

42

Odds Ratio (M‐H, Random, 95% CI)

1.28 [0.32, 5.09]

1.3 Non NF‐GNB/MRSA

1

232

Odds Ratio (M‐H, Random, 95% CI)

1.65 [0.73, 3.73]

1.4 Unspecified organism

1

30

Odds Ratio (M‐H, Random, 95% CI)

0.93 [0.21, 4.11]

2 Recurrence of pneumonia Show forest plot

3

508

Odds Ratio (M‐H, Random, 95% CI)

1.37 [0.87, 2.17]

2.1 NF‐GNB

2

176

Odds Ratio (M‐H, Random, 95% CI)

2.18 [1.14, 4.16]

2.2 MRSA

2

49

Odds Ratio (M‐H, Random, 95% CI)

1.56 [0.12, 19.61]

2.3 Non NF‐GNB/MRSA

2

253

Odds Ratio (M‐H, Random, 95% CI)

0.98 [0.55, 1.78]

2.4 Unspecified organism

1

30

Odds Ratio (M‐H, Random, 95% CI)

1.17 [0.14, 9.59]

3 28‐day antibiotic‐free days Show forest plot

2

431

Mean Difference (IV, Random, 95% CI)

4.02 [2.26, 5.78]

3.1 NF‐GNB

1

127

Mean Difference (IV, Random, 95% CI)

4.5 [2.25, 6.75]

3.2 MRSA

1

42

Mean Difference (IV, Random, 95% CI)

8.0 [4.14, 11.86]

3.3 Non NF‐GNB/ MRSA

1

232

Mean Difference (IV, Random, 95% CI)

3.70 [2.09, 5.31]

3.4 Unspecified organism

1

30

Mean Difference (IV, Random, 95% CI)

2.3 [1.03, 3.57]

4 ITU mortality Show forest plot

2

107

Odds Ratio (M‐H, Random, 95% CI)

0.85 [0.37, 1.91]

5 Non‐resolution of pneumonia Show forest plot

1

77

Odds Ratio (M‐H, Fixed, 95% CI)

1.80 [0.65, 5.02]

5.1 NF‐GNB

1

49

Odds Ratio (M‐H, Fixed, 95% CI)

1.89 [0.49, 7.40]

5.2 MRSA

1

7

Odds Ratio (M‐H, Fixed, 95% CI)

11.0 [0.28, 433.80]

5.3 Non NF‐GNB/MRSA

1

21

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.16, 6.25]

6 In‐hospital mortality Show forest plot

1

401

Odds Ratio (M‐H, Fixed, 95% CI)

1.09 [0.71, 1.67]

6.1 NF‐GNB

1

127

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.36, 1.53]

6.2 MRSA

1

42

Odds Ratio (M‐H, Fixed, 95% CI)

1.47 [0.43, 4.95]

6.3 Non NF‐GNB/MRSA

1

232

Odds Ratio (M‐H, Fixed, 95% CI)

1.32 [0.72, 2.42]

7 Recurrence due to multi‐resistant organism Show forest plot

1

110

Odds Ratio (M‐H, Fixed, 95% CI)

0.44 [0.21, 0.95]

8 Duration of ITU stay Show forest plot

2

431

Mean Difference (IV, Random, 95% CI)

‐0.01 [‐2.30, 2.27]

8.1 NF‐GNB

1

127

Mean Difference (IV, Random, 95% CI)

0.90 [‐5.40, 7.20]

8.2 MRSA

1

42

Mean Difference (IV, Random, 95% CI)

2.90 [‐8.39, 14.19]

8.3 Non NF‐GNB/MRSA

1

232

Mean Difference (IV, Random, 95% CI)

2.70 [‐1.88, 7.28]

8.4 Unspecified organism

1

30

Mean Difference (IV, Random, 95% CI)

‐1.60 [‐4.61, 1.41]

9 Duration of hospital stay Show forest plot

1

30

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐4.11, 2.11]

10 Duration of mechanical ventilation Show forest plot

2

107

Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.57, 0.55]

11 28‐day mechanical ventilation‐free days Show forest plot

2

431

Mean Difference (IV, Random, 95% CI)

0.47 [‐0.97, 1.92]

11.1 NF‐GNB

1

127

Mean Difference (IV, Random, 95% CI)

1.50 [‐1.77, 4.77]

11.2 MRSA

1

42

Mean Difference (IV, Random, 95% CI)

‐1.30 [‐6.37, 3.77]

11.3 Non NF‐GNB/MRSA

1

232

Mean Difference (IV, Random, 95% CI)

‐1.20 [‐3.54, 1.14]

11.4 Unspecified organism

1

30

Mean Difference (IV, Random, 95% CI)

1.30 [‐0.03, 2.63]

12 Mortality associated with VAP Show forest plot

1

77

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐8.85, 10.85]

Figures and Tables -
Comparison 1. Short (fixed)‐course antibiotic therapy versus prolonged‐course antibiotic therapy for HAP
Comparison 2. Discontinuation of antibiotics according to Clinical Pulmonary Infection Score

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 30‐day mortality Show forest plot

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.10, 1.03]

2 Episodes of superinfection or antimicrobial resistance Show forest plot

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.09, 0.92]

3 Duration of antibiotic therapy Show forest plot

1

81

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Duration of ITU stay Show forest plot

1

81

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Discontinuation of antibiotics according to Clinical Pulmonary Infection Score
Comparison 3. Discontinuation of antibiotics according clinical guideline

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrence of pneumonia Show forest plot

1

290

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.48, 1.59]

2 Duration of antibiotic therapy Show forest plot

1

290

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐3.21, ‐0.79]

3 In‐hospital mortality Show forest plot

1

290

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.49, 1.29]

4 Duration of ITU stay Show forest plot

1

290

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐1.75, 1.35]

5 Duration of hospital stay Show forest plot

1

290

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐3.63, 4.23]

6 Duration of mechanical ventilation Show forest plot

1

290

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐1.79, 1.19]

Figures and Tables -
Comparison 3. Discontinuation of antibiotics according clinical guideline
Comparison 4. Discontinuation of antibiotic therapy according to serum procalcitonin level

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 28‐day mortality Show forest plot

3

308

Odds Ratio (M‐H, Random, 95% CI)

0.66 [0.39, 1.14]

2 Recurrence of pneumonia Show forest plot

1

66

Odds Ratio (M‐H, Fixed, 95% CI)

2.06 [0.74, 5.70]

3 28‐day antibiotic‐free days Show forest plot

3

308

Mean Difference (IV, Random, 95% CI)

2.80 [1.39, 4.21]

4 Duration of antibiotic therapy Show forest plot

3

308

Mean Difference (IV, Random, 95% CI)

‐3.20 [‐4.45, ‐1.95]

5 In‐hospital mortality Show forest plot

1

101

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.25, 1.58]

6 ITU mortality Show forest plot

1

66

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.26, 2.22]

7 Non‐resolution of pneumonia Show forest plot

1

66

Odds Ratio (M‐H, Fixed, 95% CI)

1.17 [0.38, 3.62]

8 Recurrence due to resistant organism Show forest plot

1

66

Odds Ratio (M‐H, Fixed, 95% CI)

1.75 [0.49, 6.21]

9 ITU duration of stay Show forest plot

2

167

Mean Difference (IV, Random, 95% CI)

‐2.68 [‐6.01, 0.66]

10 Duration of hospital stay Show forest plot

1

101

Mean Difference (IV, Fixed, 95% CI)

‐2.40 [‐6.40, 1.60]

11 Duration of mechanical ventilation Show forest plot

2

167

Mean Difference (IV, Random, 95% CI)

‐0.35 [‐3.24, 2.54]

Figures and Tables -
Comparison 4. Discontinuation of antibiotic therapy according to serum procalcitonin level