Shorter antibiotic therapy is not inferior to longer therapy for community-acquired pneumonia

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According to a study published in The Lancet, three-day antibiotic therapy was not inferior to eight-day therapy in patients with moderate community-acquired pneumonia.

The researchers said the study “supported”[s] the concept that antibiotic therapy can be safely discontinued in patients with moderate community-acquired pneumonia who have an early clinical response to therapy, which could allow a significant reduction in antibiotic exposure in patients treated in hospital for community-acquired pneumonia become.”

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“In daily practice for community-acquired pneumonia, doctors often prescribe antibiotic treatment out of inherited habit for 7 to 10 days before the threat of bacterial resistance is recognized.” Aurelian palace, MD, and colleagues from the Pneumonia Short Treatment Study Group, wrote.

“This tendency is compounded by the general belief that prolonged use of antibiotics protects against re-infection and even antibacterial resistance,” they wrote. “However, short-term antibiotic treatments are one of the best ways to reduce selection pressures for antibiotic resistance, and randomized trials are needed to determine the minimum duration of treatment to ensure a cure.”

The researchers conducted a double-blind, randomized, placebo-controlled study of 310 patients 18 years of age and older who were hospitalized with community-acquired pneumonia and received 3-day beta-lactam therapy consisting of three oral amoxicillin with clavulanate for one day. After 3 days, 153 continued to receive beta-lactam therapy and 157 received matching placebo for an additional 5 days.

Researchers assessed healing – defined as a temperature of 100.4 ° F or less, symptom resolution or improvement, and no additional antibiotic therapy for any reason – after 15 days after patients first started taking antibiotics.

Cure was achieved in 77% of patients in the placebo arm and 68% of patients who received additional days of beta-lactam therapy, they reported.

Side effects were similar between treatment groups, with 22 (14%) side effects observed in the placebo group and 29 (19%) in the beta-lactam group. Indigestion, the most common side effect observed in the study, occurred in 17 (11%) of the patients on placebo and 28 (19%) of the patients on beta-lactam therapy. Three patients in the placebo group died and two patients in the beta-lactam group.

“Community-acquired pneumonia and lower respiratory tract infections in general are some of the most common indications for antibiotic use, and therefore our results support the significant reduction in antibiotic use,” the authors write.

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