The real-world study adds to findings from previous randomized controlled trials suggesting that shorter courses of antibiotics may be sufficient for hospitalized patients with mild or moderate community-acquired pneumonia.
Antibiotics are usually prescribed to treat community-acquired pneumonia (CAP), but with antimicrobial resistance being a growing concern in general health care, it is essential to minimize antibiotic use whenever possible. A study published in the journal Clinical microbiology and infection suggests that short-course antibiotic therapy produces similar results to prolonged antibiotic therapy for patients with CAP showing an early clinical response.
The multicenter observational cohort study aimed to build on previous research, particularly randomized controlled trials, suggesting that 3-5 days of antibiotic therapy may be sufficient for hospitalized patients with mild or moderate CAP who are clinically stable. before stopping treatment.
In the study, patients with CAP at 4 hospitals in Denmark were evaluated to determine the effectiveness of short course antibiotic therapy (4-7 days of treatment) compared to long course antibiotic therapy (8 at 14 days of treatment). Mortality within 30 days of antibiotic therapy was the primary endpoint, with readmissions and new antibiotic prescriptions serving as secondary outcomes.
Inclusion criteria included achieving clinical stability within 3 days of starting antibiotics and at least 1 day of follow-up after stopping treatment. Data were collected from medical records, the Danish national patient register, the Danish civil registration system and the Danish national prescription register.
A total of 2264 patients hospitalized with CABG between 2017 and 2019 were identified, and 1151 achieved clinical stability within 3 days of antibiotic therapy and met the remaining inclusion criteria. About half of the patients had reported comorbidities, including chronic obstructive pulmonary disease (COPD). Patients who achieved clinical stability were generally younger, had fewer comorbidities, and had less severe disease than those who did not. The median duration of treatment was 6 days in the short-term cohort and 9 days in the long-term cohort.
In the short-term treatment group, mortality within 30 days of the end of treatment was 3.36%, compared to 3.4% in the long-term treatment group (odds ratio adjusted [OR], 1.05; 95% CI, 0.38-1.88). The readmission rate was 15.6% in the short-term group and 14% in the long-term group (adjusted OR, 1.07; 95% CI, 0.75-1.69). The rates of new antibiotic prescriptions were 11.9% and 12.1% in the short-term and long-term cohorts, respectively.
Given the similar results between the short- and long-course antibiotic regimens in the study, the results support the use of shorter antibiotic courses for patients with mild or moderate CAP who achieve clinical stability at the start of treatment.
“These findings could serve as an important complement to randomized clinical trials by allowing their findings to be more applicable in routine clinical settings,” the authors wrote. They noted that it would have been interesting to explore the efficacy of an even shorter antibiotic course of 3 to 5 days, but the rarity of this approach at the time of the study prevented further sensitivity analyses.
“Future studies should strive to implement clinical stability criteria to guide treatment in settings of different antibiotic classes and antimicrobial resistance,” the authors concluded. “Optimally, large, multicenter randomized controlled trials should allow evaluation of safety outcomes in the implementation of short-course antibiotic therapy, which would be reassuring for both patients and clinicians.”
Israelsen SB, Fally M, Tarp B, Kolte L, Ravn P, Benfield T. Short-course antibiotic therapy for hospitalized patients with early clinical response in community-acquired pneumonia: a multicenter cohort study. Clin Microbiol Infect. Published online August 18, 2022. doi:10.1016/j.cmi.2022.08.004