Ventilator-associated pneumonia: how long is long enough?

VAP remains the leading healthcare-associated infection in intensive care units (ICUs), related to worse outcomes and contributing substantially to antimicrobial use. Historically, prolonged antibiotic courses (≥10-14) were standard, particularly for cases involving multidrug-resistant (MDR) or extensively drug-resistant (XDR) organisms. This review synthesizes current evidence supporting shorter course therapy for VAP (≤7-8 days), emphasizing the importance of clinical response and individualization. While guideline convergence on 7-8 days has grown, exceptions apply for specific pathogens (e.g., nonfermenters, MDR or XDR organisms), bacteremia, slow response, or structural lung disease. Biomarkers like procalcitonin may assist in select cases but lack VAP-specific validation. Regular reassessment is essential to balance efficacy with stewardship. Evidence gaps remain for immunocompromised patients and ultra-short regimens.