A 5-day antibiotic approach outperformed a 10-day regimen in children with nonsevere community-acquired pneumonia (CAP), according to the results of a randomized double-blind placebo-controlled trial (ClinicalTrials.gov Identifier: NCT02891915) published in JAMA Pediatrics.

The study involved 380 healthy children (aged 6 to 71 months; average age 35.7 months; 51% boys) with mild CAP who demonstrated early improvement. On day 6 of their originally prescribed therapy, participants were randomized receive either 5 days of matching placebo or 5 additional days of the same antibiotic. Study participants were enrolled between December 2016 and December 2019 from outpatient clinics, urgent care centers, and emergency settings across 8 US cities.

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


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The short-course strategy exhibited a 69% greater chance of a more beneficial RADAR outcome than standard-course treatment, with fewer than 10% of children exhibiting inadequate clinical outcomes.

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

Limitations of the current study include non-routine performance of blood culture, chest radiography, and so forth. Of note, national guidelines don’t recommend the routine use of these diagnostic tests for outpatient pneumonia.  Additionally, some of the participants may have received antibiotics for infection without a bacterial etiology. Another potential limitation is that the cohort was relatively healthy.

“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,” state the authors. “Current guidelines recommending longer courses of therapy for uncomplicated outpatient CAP warrant reexamination.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Williams DJ, Creech CB, Walter EB, et al. Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial. JAMA Pediatr. Published on January 18, 2022. doi: 10.1001/jamapediatrics.2021.5547. Epub ahead of print. PMID: 35040920; PMCID: PMC8767493.