Shorter antibiotic therapy noninferior to longer therapy for community-acquired pneumonia
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Three days of antibiotic therapy was noninferior to 8 days of therapy for patients with moderately severe community-acquired pneumonia, according to a study published in The Lancet.
The researchers said the study “support[s] the concept that antibiotic therapy can be safely discontinued in patients who have moderately severe community-acquired pneumonia who have early clinical response to therapy, which could allow an important reduction in antibiotic exposure among patients being treated in hospital for community-acquired pneumonia.”
“In daily practice for community-acquired pneumonia, physicians still often prescribe 7 to 10 days of antibiotic treatment out of habit inherited before the recognition of the threat of bacterial resistance,” Aurélien Dinh, MD, and colleagues from the Pneumonia Short Treatment Study Group, wrote.
“This tendency is reinforced by the common belief that an extended course of antibiotics protects from reinfection and even antibacterial resistance,” they wrote. “However, short-course antibiotic treatments are one of the best ways to reduce selection pressure for antimicrobial resistance, and randomized trials are needed to identify the minimum length of treatment to ensure cure.”
The researchers conducted a double-blind, randomized, placebo-controlled trial of 310 patients aged 18 years or older who were admitted to the hospital with community-acquired pneumonia and received 3 days of beta-lactam therapy consisting of oral amoxicillin with clavulanate three times a day. After 3 days, 153 continued to receive beta-lactam therapy and 157 received a matched placebo for 5 extra days.
The researchers assessed cure — defined as a temperature of 100.4°F or less, resolution or improvement of symptoms, and no additional antibiotic therapy for any cause — after 15 days from the patients’ first antibiotic intake.
Cure was achieve in 77% of patients in the placebo arm and 68% of patients who received additional days of beta-lactam therapy, they reported.
Adverse events were similar between the treatment groups, with 22 (14%) adverse events observed in the placebo group and 29 (19%) in the beta-lactam group. Digestive disorders, the most common adverse event observed in the study, occurred in 17 (11%) of patients given placebo and 28 (19%) of patients given beta-lactam therapy. Three patients in the placebo group died, as well as two patients in the beta-lactam group.
“Community-acquired pneumonia and, more generally, lower respiratory tract infection are some of the most common indications for antibiotic use, and so our findings support the substantial reduction in consumption of antibiotics,” the authors wrote.
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