Short-course of antibiotics suffices for children with pneumonia

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A five-day course of high-dose amoxicillin will do just as well for children six months to 10 years old with common pneumonia, found research from McMaster University.

"Several studies have proven that adults with pneumonia do fine with short courses of antibiotics, and now we have proved a short course of antibiotics also works for children," said Dr Jeffrey Pernica, lead study author, associate professor of paediatrics of McMaster's Michael G DeGroote School of Medicine and an infectious disease paediatrician for Hamilton Health Sciences.

The study, involving 281 Ontario children, found that 85.7% of those who received the short course of antibiotics and 84.1% of those who received the longer course of medication were cured two to three weeks later.

"The dramatic increase in antimicrobial resistance in the world today is driven by overuse of antibiotics – which has only worsened during the COVID-19 pandemic," Pernica said. "This is why we need these clinical studies – to figure out how short we can make antibiotic treatment courses for common infections."

He said there are other reasons to use the least amount of antibiotics needed to effectively treat bacterial infections, including minimising the costs of medicine. As well, he noted, a number of conditions including obesity, asthma, and arthritis, have been associated with changes in the human microbiome that can be caused by the use of antibiotics.

The research team is recommending that clinical practice guidelines prepared for health professionals consider recommending five days of amoxicillin for paediatric pneumonia.

 

Study details
Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia

Jeffrey M Pernica, Stuart Harman, April J Kam, Redjana Carciumaru, Thuva Vanniyasingam, Tyrus Crawford, Dale Dalgleish, Sarah Khan, Robert S Slinger, Martha Fulford, Cheryl Main, Marek Smieja, Lehana Thabane, Mark Loeb

Published in JAMA Pediatrics on 8 March 2021

Abstract
Importance
Community-acquired pneumonia (CAP) is a common occurrence in childhood; consequently, evidence-based recommendations for its treatment are required.
Objective
To determine whether 5 days of high-dose amoxicillin for CAP was associated with noninferior rates of clinical cure compared with 10 days of high-dose amoxicillin.
Design, Setting, and Participants
The SAFER (Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections) study was a 2-center, parallel-group, noninferiority randomized clinical trial consisting of a single-center pilot study from December 1, 2012, to March 31, 2014, and the follow-up main study from August 1, 2016, to December 31, 2019 at the emergency departments of McMaster Children’s Hospital and the Children’s Hospital of Eastern Ontario. Research staff, participants, and outcome assessors were blinded to treatment allocation. Eligible children were aged 6 months to 10 years and had fever within 48 hours, respiratory symptoms, chest radiography findings consistent with pneumonia as per the emergency department physician, and a primary diagnosis of pneumonia. Children were excluded if they required hospitalization, had comorbidities that would predispose them to severe disease and/or pneumonia of unusual origin, or had previous β-lactam antibiotic therapy. Data were analyzed from March 1 to July 8, 2020.
Interventions
Five days of high-dose amoxicillin therapy followed by 5 days of placebo (intervention group) vs 5 days of high-dose amoxicillin followed by a different formulation of 5 days of high-dose amoxicillin (control group).
Main Outcomes and Measures
Clinical cure at 14 to 21 days.
Results
Among the 281 participants, the median age was 2.6 (interquartile range, 1.6-4.9) years (160 boys [57.7%] of 279 with sex listed). Clinical cure was observed in 101 of 114 children (88.6%) in the intervention group and in 99 of 109 (90.8%) in the control group in per-protocol analysis (risk difference, −0.016; 97.5% confidence limit, −0.087). Clinical cure at 14 to 21 days was observed in 108 of 126 (85.7%) in the intervention group and in 106 of 126 (84.1%) in the control group in the intention-to-treat analysis (risk difference, 0.023; 97.5% confidence limit, −0.061).
Conclusions and Relevance
Short-course antibiotic therapy appeared to be comparable to standard care for the treatment of previously healthy children with CAP not requiring hospitalization. Clinical practice guidelines should consider recommending 5 days of amoxicillin for pediatric pneumonia management in accordance with antimicrobial stewardship principles.

 

McMaster University material

 

JAMA Pediatrics study (Restricted access)

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