Antimicrobial resistance ranks among the World Health Organisation’s top 10 global public health threats. Underpinning this phenomenon is the misuse and overuse of antibiotics, leading to the accelerated emergence of drug-resistant pathogens, or ‘superbugs’. These pathogens adapt to become increasingly resistant to conventional treatments, triggering cascading implications for both healthcare systems and the global economy. The result is a troubling scenario where once-manageable infections become challenging to treat—increasing treatment durations, hospital stays and healthcare costs, as well as elevating the risk of severe illness and mortality.

In response to this growing challenge, Dr Mo Yin, Consultant in the Division of Infectious Diseases, Department of Medicine, National University Hospital (NUH), spearheaded a study aimed at curbing the tide of antimicrobial resistance. Involving 460 patients across 39 hospital intensive care units in Nepal, Thailand and Singapore, the four-year study revealed that shortened courses of antibiotics were equally effective as the longer, conventional treatments for managing ventilator-associated pneumonia (VAP), all while significantly reducing the adverse side effects associated with such medications from 38% to 8%.

The Reducing Antibiotic tReatment Duration for Ventilator-Associated Pneumonia (REGARD-VAP) study presents a critical examination of antibiotic duration in the treatment of VAP, a significant concern in ICU settings characterised by its link to increased mortality, extended hospital admissions and higher healthcare costs. By comparing a shortened antibiotic regimen to the traditional, extended course, REGARD-VAP sought to assess the feasibility of curtailing antibiotic consumption without compromising patient health outcomes. 

“Antibiotics represent the cornerstone of VAP management, which is a common hospital-acquired infection in ICUs,” says Dr Mo. “However, their indiscriminate use, particularly in excessive quantities, renders them less effective over time due to the development of superbugs—and that formed the impetus to our study. We wanted to explore the possibility of tailoring both the duration and approach to antibiotic therapy across diverse patient profiles while making sure that it can be implemented in resource-constrained hospital environments.” 

Dr Mo, along with other researchers, designed the clinical study to ensure rigorous evaluation of treatment effectiveness and safety. Patients were randomly assigned to either a short-course treatment, lasting three to five days, or a standard treatment, extending to at least eight days. The criteria for discontinuing antibiotics were strictly informed by clinical markers, including core body temperature and blood pressure stability, ensuring a methodical and patient-centric approach to antibiotic administration.

The REGARD-VAP study also underscores the practicality and importance of individualising patient care. By adopting a personalised treatment approach, it becomes possible to modify therapeutic strategies in alignment with each patient’s response—minimising undue exposure to antibiotics and the consequent side effects.

“This not only helps us manage VAP more effectively but also contributes to the global effort of combatting antibiotic resistance,” adds Dr Mo. “We need to shift our focus on treating smarter, not longer.”