Related Experiment Video
Updated: May 2, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Duration of antimicrobial therapy in community acquired pneumonia: less is more
Marilia Rita Pinzone1, Bruno Cacopardo1, Lilian Abbo2
1Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania, Via Palermo 636, ARNAS Garibaldi Nesima, 95125 Catania, Italy.
Abstract:
Community acquired pneumonia (CAP) represents the most common cause of infection-related morbidity and mortality worldwide. Appropriate treatment of CAP is challenging and sometimes limited by the availability to obtain rapid and timely identification of the etiologic agent in order to initiate or deescalate the correct antimicrobial therapy. As a consequence, prescribers frequently select empiric antimicrobial therapy using clinical judgment, local patterns of antimicrobial resistance, and, sometimes, individual patient expectations. These issues may contribute to prolonged courses of inappropriate therapy. In this review, we discuss the evidence and recommendations from international guidelines for the management of CAP and the clinical trials that specifically addressed duration of antimicrobial therapy for CAP in adults. In randomized controlled trials comparing the clinical efficacy of a short-course antimicrobial regimen versus an extended-course regimen, no differences in terms of clinical success, bacterial eradication, adverse events, and mortality were observed. The use of biomarkers, such as procalcitonin, to guide the initiation and duration of antimicrobial therapy may reduce total antibiotic exposure and treatment duration, healthcare costs, and the risk of developing antimicrobial resistance. In clinical practice, antimicrobial stewardship interventions may improve the management of CAP and may help in reducing treatment duration. Sometimes "less is more" in CAP.
Insights
Short-course antibiotics are effective for community-acquired pneumonia (CAP). Biomarkers like procalcitonin can help reduce antibiotic use and duration, improving outcomes and combating resistance.
Area of Science:
- Infectious Diseases
- Pulmonology
- Clinical Pharmacology
Background:
- Community-acquired pneumonia (CAP) is a leading cause of infection-related death globally.
- Accurate diagnosis and timely antimicrobial selection for CAP are challenging, often leading to empiric treatment.
- This can result in prolonged and inappropriate therapy, contributing to adverse outcomes and resistance.
Purpose of the Study:
- To review evidence and guidelines for CAP management, focusing on antimicrobial therapy duration.
- To evaluate clinical trial data comparing short-course versus extended-course antibiotic regimens for CAP in adults.
- To explore the role of biomarkers and antimicrobial stewardship in optimizing CAP treatment.
Main Methods:
- Systematic review of international guidelines for CAP management.
- Analysis of randomized controlled trials comparing different durations of antimicrobial therapy for CAP.
- Discussion of biomarker-guided therapy (e.g., procalcitonin) and antimicrobial stewardship interventions.
Main Results:
- Randomized controlled trials show no significant differences in clinical success, bacterial eradication, adverse events, or mortality between short-course and extended-course antibiotic regimens for CAP.
- Biomarkers like procalcitonin may help guide initiation and duration of therapy, potentially reducing antibiotic exposure.
- Antimicrobial stewardship programs can improve CAP management and shorten treatment duration.
Conclusions:
- Shorter antibiotic courses are as effective as longer ones for community-acquired pneumonia in adults.
- Utilizing biomarkers and stewardship interventions can optimize antibiotic use, reduce duration, and mitigate antimicrobial resistance.
- A "less is more" approach to antibiotic therapy in CAP is supported by current evidence.
More Related Videos
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
09:26Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung
Published on: January 22, 2021
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:23Pharmacokinetic–Pharmacodynamic Relationship: Influence of Elimination Half-Life on Effect Duration
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:14Atypical Pneumonia
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....