Infectious Disease

In youngsters with pneumonia, the quick antibiotic course is corresponding to the lengthy one

March 09, 2021

3 min read

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Pernica reports that it has received grants from bioMerieux SA for a study on enteropathogenic diagnostics in children with severe gastroenteritis in Botswana outside of the work submitted. In the study you will find all relevant financial information from all other authors.

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A 5-day antibiotic course was as effective as the standard 10-day course for treating community-associated pneumonia in out-of-hospital children, according to a study published in JAMA Pediatrics.

Based on the results of the study, Jeffrey M. pencil case, MD, Head of the Department of Pediatric Infectious Diseases at McMaster University in Hamilton, Ontario, and colleagues said guidelines should consider recommending 5 days of amoxicillin for treating pneumonia in children according to principles of antimicrobial treatment.

They conducted a randomized clinical trial with two centers and parallel groups with no inferiority that consisted of a pilot study with one center from December 1, 2012 to March 31, 2014 and a main follow-up study from August 1, 2016. December 31, 2019 in the emergency rooms of McMaster Children’s Hospital and Children’s Hospital in Eastern Ontario.

A total of 281 participants with an average age of 2.6 years (interquartile range 1.6-4.9 years) were included. Participants had to suffer from ambulatory pneumonia (GAP) but be good enough to receive ambulatory treatment, the researchers explained.

The authors defined CAP cases with the following criteria: fever in the 48 hours before the presentation; Tachypnea, or increased work of breathing on examination; Chest x-ray findings consistent with the CAP; and a primary diagnosis of CAP per ED practitioner.

Pernica and colleagues randomly assigned participants to high-dose amoxicillin therapy at a 1: 1 ratio for 5 days, followed by 5-day placebo therapy or 5-day high-dose amoxicillin therapy, followed by another formulation of high-dose Amoxicillin for another 5 days.

The authors defined clinical healing as all of the following: initial improvement during the first 4 days after registration; significant improvement in shortness of breath and increased work of breathing; no more than a peak of fever; and the lack of a requirement for additional antibiotics or hospitalization.

In the intention-to-treat analysis, 108 of 126 children (85.7%) in the intervention group achieved clinical healing compared to 106 of 126 children (84.1%) in the control group (risk difference) [RD] = 0.023; 97.5% confidence limit [CL] -0.061).

In the protocol analysis, 101 out of 114 participants in the intervention group (88.6%) achieved clinical healing compared to 99 out of 109 children (90.8%) in the control group (RD = -0.016; 97.5 CL, -0.087) . “However, since the unilateral CL of 97.5% exceeded the non-inferiority margin of 7.5% by the risk difference, no formal conclusion of non-inferiority could be drawn in the pro-protocol analysis,” wrote Pernica and colleagues.

“In a population of previously healthy children diagnosed with CAP in Canadian EDs, results associated with 5 days of high dose amoxicillin were similar to those associated with 10 days of high dose amoxicillin,” the authors wrote. “The guidelines for clinical practice should consider recommending 5 days of amoxicillin for the treatment of pneumonia in children according to the principles of antimicrobial treatment.”

In a related editorial Sharon V. Tsay, MD, a medical worker in CDC’s Healthcare Quality Enhancement Division, and colleagues called antibiotics “the double-edged swords we like to give up.” “They save lives, but they also cause harm from adverse drug reactions and promote antibiotic resistance,” they wrote.

According to Tsay and colleagues, there is growing evidence that shorter antibiotic courses in adults can be used to treat conditions such as pneumonia. However, they found that there is a lack of evidence in this regard for children.

Currently, WHO recommends 3 to 5 days of antibiotic therapy for children worldwide, although the guidelines of the Pediatric Infectious Diseases Society and Infectious Diseases Society of America do not recommend a specific duration of antibiotic therapy for children with CAP, reported Tsay and colleagues.

“This study adds to the growing body of evidence that the optimal duration of antibiotic therapy for CAP is shorter than traditional,” wrote Tsay and colleagues. “Conducting a high-quality study in the specific target population confirms the finding that 5 days of antibiotic therapy are likely to work as well as 10 days for most children with pneumonia.”

References:

Pernica JM et al. JAMA Pediatr. 2021; doi: 10.1001 / jamapediatrics.2020.6735.

Tsay SV et al. JAMA Pediatr. 2021; doi: 10.1001 / jamapediatrics.2020.6743.

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