Short antibiotic course holds up against extended course for pediatric pneumonia

An extended course of antibiotics showed no short-term clinical benefit for children hospitalized with community-acquired pneumonia compared with a standard, shorter course, a study found.

The study was conducted by researchers in Australia, Malaysia, New Zealand and Singapore and published in The Pediatric Infectious Disease Journal.

The researchers noted that high-level evidence was limited for antibiotic duration among children from First Nations and different at-risk populations who had been hospitalized with community-acquired pneumonia (CAP).

“Despite its large disease burden, limited robust evidence exists globally to guide antibiotic treatment duration for CAP,” they wrote. “Current WHO recommendations are for 3 to 5 days’ duration in low- and middle-income countries , while antibiotics are usually prescribed for 5 to 10 days in high-income countries.”

The study included 324 children with uncomplicated CAP from Australia, New Zealand and Malaysia who were managed with IV antibiotics for 1 to 3 days, followed by 3 days of oral amoxicillin-clavulanate. After that, the researchers randomly assigned them to receive either an extended course of antibiotics lasting 13 to 14 days or a standard course lasting 5 to 6 days.

The intent-to-treat analysis included 163 children in the extended course and 161 children in the standard course arm. The researchers reported that 77.9% of children in the extended-course arm were cured clinically by week 4, compared with 81.3% of children in the standard-course arm (RR for cure = 0.96; 95% CI = 0.86-1.07). They said significantly more children in the extended-course arm required oxygen supplementation (P = .02).

“At the 4-week follow-up review, we found no short-term clinical benefit from an extended 13- to 14-day course of antibiotics in children 5 years old or younger hospitalized with CAP … when compared with a standard 5- to 6-day course,” the researchers wrote.

“Oral amoxicillin-clavulanate was well tolerated, although there was more diarrhea reported in those receiving the extended treatment course,” they continued. “Nevertheless, there were no significant between-group differences for [adverse events], nasopharyngeal bacterial colonization profiles, and [antimicrobial resistance] at the 4-week review.”

The researchers said they intended to follow the participants for another 2 years “to determine if the extended course improves long-term outcomes by reducing the prevalence of chronic respiratory symptoms and/or signs, including underlying pulmonary disorders (eg, bronchiectasis), in these high-risk children,” they wrote.