Shorter antibiotic course effective in children with community acquired pneumonia

1. There were no significant differences in clinical response, resolution of symptoms, and antibiotic-related adverse effects between a 5-day and 10-day antibiotic course used to treat non-severe community-acquired pneumonia.

2. Antibiotic-resistant genes were identified less frequently in children who received a 5-day antibiotic course compared to those who received a 10-day antibiotic course.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Community-acquired pneumonia (CAP) in children is a serious and common illness typically treated with a 10-day course of antibiotics. Previous studies have indicated that a shorter treatment duration may be equally efficacious to standard-length therapy. However, a comparison of antibiotic-related adverse effects and antibiotic resistant genes between treatment durations was not performed previously. This study compared a short (5-day) versus standard (10-day) antibiotic regimen in healthy children less than 6 years of age with non-severe CAP who were demonstrating early clinical improvement on antibiotics. Children were randomized to receive 5 additional days of placebo or their originally prescribed antibiotic. Outcomes included clinical response, resolution of symptoms, and antibiotic-related adverse effects. Presence of antibiotic resistant genes was assessed in a subset of children. There were no significant differences in clinical outcomes between the two groups. Adverse effects were common in both groups,  and antibiotic-resistant genes were significantly decreased in the group treated with a 5-day course. Overall, this study indicates that a 5-day antibiotic duration provides similar outcomes for young healthy children with non-severe CAP, and is associated with less antibiotic resistance. However, further studies that include older children, those with severe CAP, and those with pre-existing illnesses are necessary in order to expand the applicability of the results.

Click to read the study in JAMA Pediatrics

Relevant Reading: Management of severe community-acquired pneumonia of children in developing and developed countries

In-Depth [randomized controlled trial]: This randomized, double-blind, placebo-controlled trial included 380 children aged 6 to 71 months with non-severe CAP. Children were recruited from outpatient clinics, emergency departments, or urgent care centers across 8 cities in the United States between December 2016 and 2019. Children who were receiving a 5-day course of oral beta-lactam antibiotics were randomized 1:1 on day 6 of treatment to receive 5 days of either placebo or their originally prescribed antibiotic. Outcomes included clinical response (i.e., absence of a medical visit, surgery, or non-study antibiotics for worsening symptoms), resolution of symptoms (i.e., absence of fever, elevated respiratory rate, or moderate/severe cough), and antibiotic-related adverse effects (i.e., irritability, diarrhea, vomiting, allergic reaction, stomatitis, or candidiasis), which were evaluated on days 6-10 and 19-25 of the study. Outcomes were then further adjusted for duration of antibiotic use, with an a priori assumption that a shorter treatment duration is preferable when treatment outcomes are similar. Additionally, 171 children consented for a throat swab to detect the presence of antibiotic-resistant genes. Overall, there were no significant differences between groups in clinical response, resolution of symptoms, or adverse effects. There were significantly lower resistant genes present in the shorter-course group (p = 0.01).

Image: PD

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