The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children. (11th June 2020)

• Record Type: Journal Article
• Authors: Same, Rebecca G; Amoah, Joe; Hsu, Alice J; Hersh, Adam L; Sklansky, Daniel J; Cosgrove, Sara E; Tamma, Pranita D
• Is Part Of: Journal of the Pediatric Infectious Diseases Society. Volume 10:Number 3(2021)
• Page Start: 267
• Page End: 273
• Publication Date: 2020-06-11
• Subjects: antibiotics -- bacterial pneumonia -- duration of therapy -- pediatrics; Communicable diseases in children -- Periodicals; Children -- Diseases -- Periodicals; 618.929
• DOI: 10.1093/jpids/piaa055
• Languages: English
• ISSNs: 2048-7193

Abstract

Abstract: Background: National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes of children hospitalized with CAP who receive shorter durations of therapy have not been evaluated. Methods: We conducted a comparative effectiveness study of children aged ≥6 months hospitalized at The Johns Hopkins Hospital who received short-course (5–7 days) vs prolonged-course (8–14 days) antibiotic therapy for uncomplicated CAP between 2012 and 2018 using an inverse probability of treatment weighted propensity score analysis. Inclusion was limited to children with clinical and radiographic criteria consistent with CAP, as adjudicated by 2 infectious diseases physicians. Children with tracheostomies; healthcare-associated, hospital-acquired, or ventilator-associated pneumonia; loculated or moderate to large pleural effusion or pulmonary abscess; intensive care unit stay >48 hours; cystic fibrosis/bronchiectasis; severe immunosuppression; or unusual pathogens were excluded. The primary outcome was treatment failure, a composite of unanticipated emergency department visits, outpatient visits, hospital readmissions, or death (all determined to be likely attributable to bacterial pneumonia) within 30 days after completing antibiotic therapy. Results: Four hundred and thirty-nine patients met eligibility criteria; 168 (38%) patients received short-course therapy (median, 6 days) and 271 (62%) received prolonged-course therapy (median, 10 days). Four percent of children experienced treatment failure, with no differences observed between patients who received short-course vs prolonged-course antibiotic therapy (odds ratio, 0.48; 95% confidence interval, .18–1.30). Conclusions: A short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP. Abstract : National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia. In a propensity-weighted cohort of 439 children hospitalized for uncomplicated community-acquired pneumonia, short-course antibiotic therapy (median, 6 days) resulted in similar outcomes as prolonged-course therapy (median, 10 days).