Shorter course of antibiotics OK for children with pneumonia who are improving
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Among children with community-associated pneumonia who have improved by day 5, study findings showed that additional days of antibiotic therapy did not confer additional benefits, researchers reported during IDWeek.
“This study provides the data needed to shorten the course of antibiotics for many children with community-associated pneumonia,” Infectious Diseases in Children Editorial Board Member C. Buddy Creech, MD, MPH, director of the vaccine research program at Vanderbilt University School of Medicine, told Healio.
Creech and colleagues enrolled 385 children in a randomized, double-blind, placebo-controlled superiority trial to study the standard 10-day course of antibiotics for children with community-associated pneumonia (CAP) with a shorter 5-day antibiotic course. They randomly assigned 385 children aged 6 to 71 months at a 1:1 ratio to receive either 5 additional days of the standard prescribed antibiotic or a placebo. Complete data were available for 380 children.
The primary outcome was Desirability of Outcome Ranking (DOOR) — “defined by classifying the global experience of children into an ordinal clinical response (OCR) that combined the response to CAP treatment and antibiotic adverse effects 11-15 days after the start of therapy,” the researchers explained.
In both the standard and shorter treatment arms, more than 90% of children had adequate responses, and adverse effects were minor. In the OCR analysis, there was a 48% probability of a more desirable outcome with short-course therapy (95% CI, 42%-53%). In the DOOR analysis, that number was 69% (95% CI, 63%-72%).
“Antibiotics are a bit like Goldilocks — we want to take them for long enough, but not too long,” Creech said. “This study shows that 5 days are in fact better than 10 days for those that are improving. As a result, clinicians may choose to provide shorter courses of therapy for uncomplicated CAP, extending the course of antibiotics for those that aren’t yet improved.”
In their analysis, the authors used an a priori assumption that a shorter course of antibiotics is “more desirable.”
“By ranking the outcomes of children based on both antibiotic side effects and clinical outcomes, we can look at health outcomes holistically. Since half of the children received 10 days and half received 5 days, we can then rank everyone’s outcomes,” Creech said. “If a child receiving 10 days ends up with the same rank as someone who got 5 days, then the child who received 5 days of therapy automatically gets a better rank statistically. This is what allows us to say that 5 days is indeed superior to 10 day. Since a 5-day course is inherently better than a 10-day course, we can say with a high degree of confidence than 5 days is statistically superior.”