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Kids with pneumonia who respond to five days of antibiotics probably don’t need more

JAMA Pediatrics
Reuters Health - 18/01/2022 - Children with community-acquired pneumonia (CAP) who respond to five days of antibiotic therapy can probably safely forego another five days of treatment, according to results of a randomized controlled trial. 

"The shortened approach resulted in similar clinical response and antibiotic-associated adverse effects, while reducing antibiotic exposure and resistance," researchers report in JAMA Pediatrics. 

"We think that with these data, pediatricians can be confident that a shorter course of antibiotics (5 days) treats pneumonia as well as 10 days of antibiotics in children who are responding quickly to treatment. The shorter course is easier to complete and appears to reduce the amount of antibiotic resistance in the normal bacteria of the GI tract," Dr. C. Buddy Creech with Vanderbilt University Medical Center in Nashville, Tennessee, told Reuters Health by email. 

Childhood CAP is usually treated with a 10-day course of antibiotics. The SCOUT-CAP trial enrolled 380 healthy children (mean age, 35.7 months; 51% male) with non-severe CAP who demonstrated an early clinical improvement after five days of antibiotic treatment. 

Starting on day six of their originally prescribed treatment, roughly half were randomly assigned to five additional days of the same antibiotic treatment and half of matching placebo. 

The five-day antibiotic strategy was superior to a 10-day strategy by achieving "similar clinical response, resolution of symptoms, and antibiotic-associated adverse effects with fewer days of antibiotic therapy," the study team reports. 

Fewer than 10% of children in both groups had inadequate clinical response or persistent symptoms. 

Antibiotic-associated adverse effects were common, typically mild, and did not differ by treatment strategy. 

The short-course strategy was associated with a significantly lower frequency of antibiotic resistance genes detected in throat swabs at the end of treatment. 

"Our study supports a five-day treatment strategy over longer antibiotic courses for previously healthy young children with outpatient CAP who demonstrate early clinical improvement," the study team writes. 

"Providing the shortest duration of antibiotics necessary to effectively treat an infection is a central tenet of antimicrobial stewardship and a convenient and cost-effective strategy for caregivers," they add. 

"With an estimated 1.5 million ambulatory visits for CAP annually, reducing treatment from 10 to five days for outpatient CAP could result in a reduction of up to 7.5 million antibiotic days in the US each year. Current guidelines recommending longer courses of therapy for uncomplicated outpatient CAP warrant reexamination," they point out. 

"For pneumonia, we now know that many cases are due to viruses, rather than bacteria, and antibiotics may not be necessary at all. The first step in getting to that point is shortening the antibiotic treatment course for infections where we can," Dr. Creech told Reuters Health. 

The study had no commercial funding. 

SOURCE: https://bit.ly/3nxJgBO JAMA Pediatrics, online January 18, 2022. 

By Megan Brooks 

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