Is extended superior to standard antibiotic course in children hospitalized with CAP?

11 Jul 2022
Is extended superior to standard antibiotic course in children hospitalized with CAP?

An extended antibiotic course appears to be not any better than a standard course at achieving clinical cure among children hospitalized with community-acquired pneumonia (CAP) and at risk of chronic respiratory illnesses at 4 weeks, a study has shown.

“As part of a larger study, we determined whether an extended antibiotic course is superior to a standard course for achieving clinical cure at 4 weeks in children 3 months to ≤5 years old hospitalized with CAP,” the authors said.

This multinational, double-blind, superiority randomized controlled trial was conducted on children hospitalized with uncomplicated, radiographic-confirmed CAP in Malaysia, Australia, and New Zealand. Participants received 1‒3 days of intravenous antibiotics followed by 3 days of oral amoxicillin-clavulanate (80 mg/kg, amoxicillin component, divided twice daily) and were then randomized to extended (13‒14 days duration) or standard (5‒6 days) antibiotics.

Clinical cure (complete resolution of respiratory symptoms/signs) 4 weeks postenrolment was the primary outcome. Secondary ones included adverse events, nasopharyngeal bacterial pathogens, and antimicrobial resistance at 4 weeks.

A total of 372 children were identified, of which 324 met the eligibility criteria. Intention-to-treat analysis revealed similar cure rates between groups (extended course: n=127/163, 77.9 percent; standard course: n=131/161, 81.3 percent; relative risk, 0.96, 95 percent confidence interval [CI], 0.86‒1.07).

In addition, no significant between-group differences were observed in adverse events (extended course: n=43/163, 26.4 percent; standard course: n=32/161, 19.9 percent) or nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus or antimicrobial resistance.

“Additional research will identify if an extended course provides longer-term benefits,” the authors said.

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