Short Antibiotic Therapy Good Enough For Community-Acquired
Duration of antibiotic therapy is a key decision in the management of community-acquired pneumonia. In a recent study, researchers have found that discontinuing beta-lactam treatment after three days was non-inferior to 8 days of treatment in patients with community-acquired pneumonia. Shortening the duration of therapy could lead to fewer antibiotic side-effects, less pressure for antimicrobial resistance, reduced costs, and a reduced risk of bacterial superinfection.

However, these benefits must be weighed against the potential harm from recurrent illness. Therefore, researchers, conducted a study to examine the need for an additional 5-day course of beta-lactam therapy among patients with community-acquired pneumonia who were stable after three days of treatment.

The researchers included a total of 310 eligible patients with severe community-acquired pneumonia. They randomly assigned the patients to receive either beta-lactam treatment or placebo for 5 extra days. The major outcome assessed was cure 15 days after first antibiotic intake, defined by apyrexia, resolution or improvement of respiratory symptoms, and no additional antibiotic treatment for any cause.

Key findings of the study were:

• In the ITT analysis, the researchers noted that cure at day 15 occurred in 77% of participants in the placebo group and 68% of participants in the beta-lactam group, indicating non-inferiority.

• Results of the per-protocol analysis also indicated non-inferiority, with 78% of patients in the placebo group and 68% of patients in the beta-lactam group cured at day 15.

• The observed similar incidence of adverse events between the treatment groups.

• The most common adverse event was digestive disorders. Also, by day 30, they reported three deaths in the placebo group and two deaths in the beta-lactam group.

The authors concluded, Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing beta-lactam treatment after 3 days was non-inferior to 8 days of treatment. These findings could allow a substantial reduction of antibiotic consumption.

Source:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00313-5/fulltext
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