In this controlled cross over trial, 6000 ICU patients were randomized to digestive decontamination (IV cefotaxime for 4 days, and oral tobramycin/colistin/amphotericin), oral decontamination (same oral regimen), or standard care. The (adjusted) absolute risk reduction of 28 day death was 3.5% in the digestive decontamination group, and 2.9% in the oral decontamination group (for NNT of 29 and 34 respectively). There was no difference in antibiotic-resistant pathogens or Cdiff among the study groups. At an estimated cost of $1/day, the authors endorse the oral decontamination regimen to gain significant mortality advantage, with no apparent disadvantages (abstract)
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