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Shortened antibiotic therapy does not threaten CAP patients’ outcomes
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Community-acquired pneumonia patients who received shortened antibiotic regimens based on recommendations by the Infectious Diseases Society of America and American Thoracic Society demonstrated similar clinical outcomes to those whose antibiotic therapy was determined by physician decision alone, according to data recently published in JAMA Internal Medicine.
“Reducing the duration of treatment remains challenging in clinical practice, probably because of physicians feeling a false sense of security with longer treatments,” Ane Uranga, MD, of the pneumology department at Galdakao-Usansolo Hospital, Barakaldo, Spain, and colleagues wrote. “To date, no clinical trials have been conducted concerning duration of antibiotic treatment in a real-world setting where clinicians can prescribe their drug of choice among hospitalized patients with [community-acquired pneumonia (CAP)] with varying degrees of illness.”
Clinical guidelines for antibiotic treatment duration published by IDSA and ATS in 2007 suggest a minimum of 5 days of therapy, with longer treatments recommended if the initial therapy was not active against the pathogen or if the patient’s condition was unstable or otherwise complicated.
To validate the recommendation for shorter antibiotics for CAP, Uranga and colleagues enrolled 312 Spanish CAP patients into a multicenter randomized clinical trial from January 2012 through August 2013. Participants were aged at least 18 years, diagnosed by chest radiography plus symptoms and were not immunocompromised. The researchers compared 10- and 30-day clinical outcomes between patients whose antibiotic therapy followed the IDSA/ATS recommendations and a control group whose treatment was determined by physicians as in clinical practice.
Baseline demographics and characteristics were similar between the intervention (n = 162) and control groups (n = 150). Nearly 80% of patients in both groups received quinolone treatments, while less than 10% received beta-lactam plus macrolide. The average age of participants was 66.2 years in the control group and 64.7 years in the intervention group.
In the intent-to-treat analysis, 10-day clinical success was achieved by 48.6% of control patients and 56.3% of intervention patients, while 88.6% of controls and 91.9% of intervention patients reported success at 30 days. The researchers observed no differences in 10- and 30-day clinical success rates during the per-protocol analysis, while mean CAP symptom questionnaire scores collected at days 5 and 10 were comparable between the groups during both analyses.
According to the researchers, these findings indicate that the shorter antibiotics courses recommended in the guidelines do not jeopardize clinical outcomes or patient-reported wellness and provide numerous secondary benefits.
“Determining the duration of antibiotic treatment based on clinical response appears to be a better strategy than using arbitrary treatment lengths,” they wrote. “Shorter treatments also led to less antimicrobial resistance, fewer adverse effects, lower cost and improved adherence.”
The data from this study and others challenge decades of prior antibiotic practice, Brad Spellberg, MD, chief medical officer at the Los Angeles County-University of Southern California Medical Center, wrote in a related editorial. He emphasized the benefits of short course therapies and urged health care providers to seek opportunities to end treatment early.
“What should we do when patients are given a prescription for a fixed duration of therapy and their symptoms resolve before they complete the course?” Spellberg asked. “Here we need to change the dogma: Patients should no longer be told to keep taking the antibiotic. Patients should be told that if their symptoms resolve before completing the antibiotic they should communicate with their physician to determine if they can stop therapy early.” – by Dave Muoio
Disclosures: Uranga and colleagues report no relevant financial disclosures. Spellberg reports relationships with BioAIM, Cempra, Dipexium, Entasis, Genentech, MedImmune/AstraZeneca, Merck, Motif, PTC Therapeutics, Synthetic Biologics and The Medicines Company.
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