In the antibiotic treatment of children with pneumonia, the short course of treatment is equivalent to the long course of treatment?

A recent study showed that a 5-day course of antibiotics is as effective as a standard 10-day course in the treatment of community-associated pneumonia in non-hospitalized children.

According to the results of the study, Jeffrey M.
Pernica, MD, director of the Department of Pediatric Infectious Diseases at McMaster University in Hamilton, Ontario, and his colleagues said that follow-up guidelines should consider the principles of antimicrobial management and recommend 5-days for the management of pediatric pneumonia.
A course of amoxicillin antibiotic treatment.

Edited by Yimaitong, please do not reprint without authorization.

Research Introduction The researchers conducted a dual-center, parallel-controlled, non-inferiority randomized clinical trial at McMaster Children's Hospital and Eastern Ontario Children's Hospital Emergency Center from December 1, 2012 to March 31, 2014 , Including a single-center pilot study and a follow-up main study from August 1, 2016 to December 31, 2019.

 The study included 281 participants with a median age of 2.
6 years (IQR 1.
6 to 4.
9 years).

Participants have community-associated pneumonia, but must be healthy enough to be treated as an outpatient.

Researchers define community-associated pneumonia should have the following criteria: fever within 48 hours before onset; shortness of breath, or increased work of breathing during examination; chest X-ray results in line with community-associated pneumonia manifestations; in line with the emergency doctor’s initial diagnosis of community-associated pneumonia .

 The researchers randomly gave participants a 1:1 ratio of high-dose amoxicillin for 5 days and then treated with placebo for 5 days; or used high-dose amoxicillin for five days, and then given different dosage forms of high-dose axillin Moxilin was treated for 5 days.

They defined clinical cure as initial improvement within the first 4 days after enrollment; significant improvement in dyspnea and respiratory work; no more than one peak of fever; no need for additional antibacterial drugs or hospitalization.

 Main findings: ➤ In the intention-to-treat analysis, 108 (85.
7%) of 126 children in the intervention group were clinically cured, while 106 (84.
1%) of 126 children in the control group were clinically cured [RD=0.
023 ; 97.
5% confidence limit (CL) -0.
061)].

 ➤ In compliance with the protocol set analysis, 101 (88.
6%) of 114 participants in the intervention group were clinically cured, and 99 (90.
8%) of 109 children in the control group were clinically cured (RD=-0.
016; 97.
5%) CL -0.
087).

However, the researchers report that because the one-sided 97.
5% confidence interval surrounding the risk difference exceeds the 7.
5% non-inferiority limit, it is impossible to draw a formal conclusion of non-inferiority in the analysis according to the plan.

 The researchers said that among children diagnosed with community-associated pneumonia by the Canadian Emergency Center, the results of using high-dose amoxicillin for 5 days and using high-dose amoxicillin for 10 days were comparable.

Therefore, it is recommended that clinical practice guidelines should consider the 5-day amoxicillin regimen recommended for the treatment of childhood pneumonia based on the principles of antimicrobial management.

 Expert comment In a related editorial, Sharon V.
Tsay, MD, medical officer of the Department of Medical Quality Promotion of the Centers for Disease Control and Prevention, and his colleagues called antibiotics "our favorite double-edged sword.
"
They wrote: "Antibiotics save lives, but they can also cause harm due to adverse drug events and increased antibiotic resistance.

"
According to Tsay and colleagues, more and more evidence supports the use of shorter courses of antibiotics in adults to treat diseases such as pneumonia.

However, they pointed out that there is still a lack of evidence on children in this regard.

 At present, although the guidelines from the Pediatric Infectious Diseases Society and the American Academy of Infectious Diseases do not give specific time recommendations for the use of antibiotics for children with CAP, WHO has recommended that children around the world use antibiotics for 3 to 5 days, Tsay and colleagues report .

They also pointed out that this study provides more and more evidence that the optimal duration of antibiotic treatment for community-associated pneumonia is shorter than traditionally understood, especially the high-quality trials conducted in specific target populations have strengthened This realization-for most children with pneumonia, 5-day antibiotic therapy is likely to be equally effective compared to 10-day antibiotic therapy.

References: [1] In children with pneumonia, short course of antibiotics comparable to long course – Healio News – Mar 19,2021[2] Pernica JM, Harman S, Kam AJ, et al.
(2021) Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial.
JAMA Pediatr.
DOI:10.
1001/jamapediatrics.
2020.
6735