Shorter antibiotic course appears effective in community-acquired pneumonia treatment

The need for antibiotic stewardship to slow the rise of antibiotic resistant bacteria has raised questions about just how long a person requires antibiotics to successfully treat an illness. An investigation in JAMA Pediatrics examined whether a short-course antibiotic therapy was inferior to the standard 10 day course of antibiotics for the treatment of community-acquired pneumonia in children aged 6 months to 10 years, in an outpatient setting.¹

Investigators used data from a pilot study that ran from December 2012 to March 2014 and a follow-up study from August 2016 to December 2019. Children were eligible for the study if they were aged 6 months to 10 years, had fever within 48 hours, respiratory symptoms, chest radiography findings that were consistent with pneumonia, and a primary diagnosis of pneumonia. Those who required hospitalization, comorbidities that predisposed the child to severe disease, pneumonia of unusual origin, or previous β-lactam antibiotic therapy were excluded from the study. Treatment allocation was blinded for research staff, participants, and outcome assessors. The intervention group received 5 days of high-dose amoxicillin therapy followed by 5 days of placebo and the control group received 5 days of high-dose amoxicillin and then a different formulation of high-dose amoxicillin for 5 days.

A total of 281 participants were included in the study. Investigators noted clinical cure in 101 of 114 children in the intervention group and 99 of 109 in the control group, in a per-protocol analysis (risk difference, −0.016; 97.5% confidence limit, −0.087). In an intention-to-treat analysis (risk difference, 0.023; 97.5% confidence limit, −0.061), clinical cure at 14 to 21 days was noted in 108 of 126 children in the intervention group and 106 of 126 children in the control group.

The investigators concluded that a 5-day course of antibiotic therapy seemed to be similar to the standard 10-day course of antibiotics, when treating previously healthy children with community-acquired pneumonia who did not require a hospital stay. They also said that guidelines should consider recommending 5 days of antibiotics to meet antibiotic stewardship.

Reference

1. Pernica J, Harman S, Kam A, et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia. JAMA Pediatr. March 8, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.6735