Short-acting antibiotics in children with community-acquired pneumonia

A 5-day antibiotic approach outperformed a 10-day regimen in children with non-severe community-acquired pneumonia (CAP), according to results from a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identify: NCT02891915) Posted in JAMA Pediatrics.

The study involved 380 healthy children (aged 6-71 months; mean age 35.7 months; 51% male) with mild CAP who demonstrated early improvement. On day 6 of their initially prescribed treatment, participants were randomized to receive either 5 days of matching placebo or an additional 5 days of the same antibiotic. Study participants were recruited between December 2016 and December 2019 from outpatient clinics, urgent care centers, and emergency departments in 8 US cities.

The primary endpoint of the study was antibiotic risk duration-adjusted end-of-treatment response (RADAR). This composite outcome ranked each participant’s clinical response, resolution of symptoms, and adverse effects due to antibiotics in an ordinal ranking of outcome desirability. Each participant’s ranking also took into account the number of days of antibiotics, with a higher ranking given to shorter courses of antibiotics. A subset of patients received throat swabs to examine antibiotic resistance genes.


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The short-course strategy had a 69% greater chance of achieving a more beneficial RADAR outcome than the standard treatment, with less than 10% of children showing inadequate clinical outcomes.

The median number of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly decreased in the short-course strategy compared to the standard treatment strategy for total RGPC (P =.01) and β-lactamase RGPC (P =.03).

Limitations of the current study include the unsystematic performance of blood culture, chest X-ray, etc. It should be noted that national guidelines do not recommend the routine use of these diagnostic tests for ambulatory pneumonia. Additionally, some of the participants may have received antibiotics for an infection without a bacterial etiology. Another potential limitation is that the cohort was relatively healthy.

“Providing the shortest duration of antibiotics needed to effectively treat an infection is a central tenet of antimicrobial stewardship and a practical, cost-effective strategy for caregivers,” the authors state. “Current guidelines recommending longer treatments for re-examination of outpatient CAP without complications.”

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 CB, Walter EB, et al. Short or standard outpatient antibiotic therapy for community-acquired pneumonia in children: the SCOUT-CAP randomized clinical trial. JAMA Pediatrician. Published January 18, 2022. doi: 10.1001/jamapediatrics.2021.5547. Epub ahead of print. PMID: 35040920; PMCID: PMC8767493.

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