Safe, Effective Shorter Course of Antibiotics for Uncomplicated Childhood CAP

According to the results of a clinical trial recently published in JAMA Pediatrics.

The randomized, double-blind, placebo-controlled study included a total of 380 patients aged 6 to 71 months with non-severe CAP who demonstrated early clinical improvement on an outpatient basis. Beginning on day 6, patients were randomized (1:1) to receive either 5 days of the same antibiotic they were prescribed or a matching placebo.

“The primary endpoint was the Antibiotic Risk Duration-Adjusted End-of-Treatment Response (RADAR), a composite endpoint that ranks each child’s clinical response, resolution of symptoms and adverse effects associated with antibiotics in an ordinal desirability of outcome ranking (GATE),” the authors explained.

To assess the presence of antibiotic resistance genes in the oropharyngeal flora, throat swabs were collected from a subset of children between days 19 and 25 of the study.

Of the total number of patients included in the study, 189 received the shortened treatment while 191 followed the standard treatment. The mean (SD) age of the patients was 35.7 (17.2) months and 51% of the population was male.

The results revealed no differences between the treatment courses when evaluating the gate or its individual components. Inadequate clinical response was observed in less than 10% of patients in either treatment strategy.

“The short duration strategy had a 69% probability (95% CI, 63-75) of achieving a more desirable RADAR outcome than the standard duration strategy,” the study authors added.

Additionally, the resistome substudy, which included a total of 171 patients, demonstrated that the 5-day treatment was associated with a significantly lower number of antibiotic resistance genes.

According to the results of this study, a guideline-recommended 5-day antibiotic strategy appears to be as effective as a 10-day regimen, while also reducing antibiotic exposure and resistance in children with non-ambulatory CAP. complicated.

“Implementation of this strategy is encouraged to optimize treatment efficacy, reduce unnecessary antibiotic use, and reduce the prevalence of antibiotic resistance genes among colonizing oropharyngeal flora,” the authors concluded.

Disclosure: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original citation for a full list of author disclosures.

Reference

Williams DJ, Creech B, Walter EB, et al. Short or standard outpatient antibiotic therapy for community-acquired pneumonia in children: SCOUT-CAP randomized clinical trial. JAMA Pediatrics. Published online January 18, 2022. doi:10.1001/jamapediatrics.2021.5547

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