The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) has been debated for some time. A recent study shows that a shorter period of antibiotic therapy can be as safe and effective as current standard duration. This finding shows that new guidelines for the treatment of hospitalized adults with CAP by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) can be safely implemented in these patients.
The study, “Duration of Antibiotic Treatment in Community-Acquired Pneumonia – A Multicenter Randomized Clinical Trial,” was published by Dr. Ane Uranga, MD, and her colleagues in the journal JAMA Internal Medicine.
This multi-center clinical trial conducted in four teaching hospitals in Spain from Jan. 1, 2012, to Aug. 31, 2013, and included 312 hospitalized patients diagnosed with CAP. After five days in the hospital, 150 patients were randomly placed in the control group and received standard antibiotic treatment determined by the doctor, and 162 patients were included in the intervention group, receiving antibiotic treatment for a minimum of five days.
In the intervention group, treatment was stopped after five days if a patient’s body temperature reached 100.04°F degrees or less for 48 hours, and patients had no more than one sign of clinical instability related with CAP.
These signs included systolic blood pressures, hearts rates, respiratory rates, and arterial oxygen saturation rates.
The authors observed that the shorter antibiotic therapy was more successful than the standard therapy after 10 days from patients’ admission to the hospital (50.4 percent of participants in the control group and 59.7 percent in the intervention group), and after 30 days (92.7 percent of participants in the control group and 94.4 percent in the intervention group).
They also reported a successful outcome for patients treated for only five days in 70.1 percent in the intervention group. These results support that shortening antibiotic therapies can be as safe and effective than longer therapies, but with more advantages to the patients.
In fact, according to the authors, shortened antibiotic therapies have many advantages, such as lower rates of bacterial resistance to drugs, reduced therapy costs, reduced number of adverse effects induced by the drugs, and higher adherence to the treatment.
“(…) specifically for pneumonia, studies have shown that longer courses of therapy result in more emergence of antibiotic resistance, which is consistent with everything we know about natural selection, the driver of antibiotic resistance,” wrote Dr. Brad Spellberg, MD, in an editorial accompanying the study.
Spellberg said patients should be aware that their therapy can be stopped earlier than expected if their doctor understands that their symptoms are resolved. Therapies should, therefore, be tailored according to each case, and not continued beyond the resolution of the infection, because this can at times enhance future resistance to antibiotics.