Shorter Antibiotic Course Safe, Effective for Uncomplicated Childhood CAP

The safety and efficacy of a shorter 5-day course of antibiotics were found to be comparable to a standard 10-day course in children with uncomplicated community-acquired pneumonia (CAP), according to the findings 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 nonsevere CAP who demonstrated early clinical improvement in an outpatient setting. Beginning on day 6, patients were randomly assigned (1:1) to receive either 5 days of the same antibiotic they were prescribed or a matching placebo.

“The primary end point was the end-of-treatment response adjusted for duration of antibiotic risk (RADAR), a composite end point that ranks each child’s clinical response, resolution of symptoms, and antibiotic-associated adverse effects in an ordinal desirability of outcome ranking (DOOR),” the authors explained.

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

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

Findings revealed no differences between the treatment courses when assessing the DOOR or its individual components. Inadequate clinical response was observed in less than 10% of patients in either treatment strategy.

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

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

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

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

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

This article originally appeared on MPR