The real-world study adds to previous randomized controlled trial findings suggesting that shorter courses of antibiotic therapy can be sufficient for hospitalized patients with mild or moderate community-acquired pneumonia.
Antibiotics are typically prescribed to treat community-acquired pneumonia (CAP), but with antimicrobial resistance a growing concern in health care overall, minimizing the use of antibiotics where possible is key. 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 early clinical response.
The observational multicenter cohort study aimed to build upon previous research, particularly randomized controlled trials, suggesting that 3-5 days of antibiotic therapy can be sufficient for hospitalized patients with mild or moderate CAP who are clinically stable before discontinuing treatment.
In the study, patients with CAP at 4 hospitals in Denmark were assessed to determine the efficacy of short-course antibiotic therapy (4-7 days of treatment) versus prolonged-course antibiotic therapy (8-14 days of treatment). Mortality within 30 days of antibiotic therapy was the primary end point, with readmissions and new antibiotic prescriptions serving as secondary outcomes.
Inclusion criteria included reaching clinical stability within 3 days of starting antibiotics and at least 1 day of follow-up after ceasing treatment. Data were gathered from medical records, the Danish National Patient Registry, the Danish Civil Registration System, and the Danish National Prescription Registry.
A total of 2264 patients hospitalized for CAP between 2017 and 2019 were identified, and 1151 experienced clinical stability within 3 days of antibiotic therapy and met the remaining inclusion criteria. Approximately half of the patients had reported comorbidities, including chronic obstructive pulmonary disorder (COPD). The patients who reached clinical stability were typically younger, had fewer comorbidities, and had less severe disease compared with those who did not. The median length of treatment was 6 days in the short-course cohort and 9 days in the prolonged-course cohort.
In the short-course group, mortality within 30 days of therapy completion was 3.36%, versus 3.4% in the prolonged-course group (adjusted odds ratio [OR], 1.05; 95% CI, 0.38-1.88). The readmission rate was 15.6% in the short-course group and 14% in the long-course group (adjusted OR, 1.07; 95% CI, 0.75-1.69). The rates of new prescriptions for antibiotics were 11.9% and 12.1% in the short-course and long-course cohorts, respectively.
Considering the similar outcomes between short-course 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 early on in treatment.
“These results could serve as an important adjunct to randomized clinical trials by enabling their findings to be more applicable in routine clinical settings,” the authors wrote. They noted that exploring the efficacy of an even shorter antibiotic course of 3-5 days would have been interesting, 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 therapy in settings of different antibiotic classes and antimicrobial resistance,” the authors concluded. “Optimally, large multi-center randomized controlled trials should enable the assessment of safety outcomes in implementing 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 hospitalised patients with early clinical response in community-acquired pneumonia: a multicentre cohort study. Clin Microbiol Infect. Published online August 18, 2022. doi:10.1016/j.cmi.2022.08.004