De-escalation therapy: is it valuable for the management of ventilator-associated pneumonia?

In therapy for ventilator-associated pneumonia, it is essential to get initial empiric therapy correct; this is challenging because many patients are infected with multidrug-resistant pathogens. The need for achieving appropriate therapy can lead to broad-spectrum empiric therapy, which can represent antibiotic overuse and promote even more resistance. In an effort to combat this problem, de-escalation therapy has been proposed, with the goals of reducing the number of drugs, the spectrum of therapy, and the duration of therapy. This review examines the factors associated with an effective de-escalation strategy and ways to increase the rates of de-escalation in the future.