[Short antibiotic therapy in hospitalized pneumonia: A cohort study]
L Bouyakoub1, A Dinh2, D Blez3
1Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France.
Introduction:
Pneumonia is one of the most common indications for antibiotic. Shortening the duration of antibiotic therapy should help reduce bacterial resistance. To date, three randomized control trials have shown non-inferiority of short courses of antibiotic therapy (3 days) compared with 7 days in non-severe pneumonia. The aim of this study was to assess this strategy in real life.
Method:
This retrospective observational cohort study included all patients with pneumonia hospitalized in an internal medical ward from 11/01/2022 to 05/31/2023. We implemented the strategy based on early discontinuation of antibiotic therapy in patients with pneumonia who were clinically stable after 3 days of β-lactam treatment.
Results:
Among 49 patients included, median age was 72, median antibiotic duration was 4 days (IQR 3-6), and cure rate at D30 was 88 %. At day 30, we observed one death (2 %), four new antibiotic therapy (9 %), and two new hospitalisation (5 %), among five immunosuppressed patients. Among immunosuppressed patients (n=17; 35 %), failure rate was three times higher in case of short antibiotic courses (3/8; 38 %) than long antibiotic courses (1/7; 14 %).
Conclusion:
Strategy based on early discontinuation of antibiotic therapy in immunocompetent patients with pneumonia who were clinically stable after 3 days of β-lactam treatment is safe, and easy to implement in a medical ward.
Insights
Shortening antibiotic treatment for pneumonia to 3 days is safe for immunocompetent patients. This strategy reduces bacterial resistance and is easily implemented in medical wards.
Area of Science:
- Infectious Diseases
- Pharmacology
- Public Health
Background:
- Pneumonia necessitates antibiotic use, contributing to bacterial resistance.
- Shortening antibiotic duration (3 vs. 7 days) shows non-inferiority in non-severe pneumonia.
- Real-world assessment of a 3-day antibiotic discontinuation strategy is needed.
Purpose of the Study:
- To evaluate the real-world effectiveness of a 3-day antibiotic discontinuation strategy for pneumonia.
- To assess the safety and feasibility of early antibiotic cessation in hospitalized pneumonia patients.
Main Methods:
- Retrospective observational cohort study (11/01/2022–05/31/2023).
- Included patients with pneumonia hospitalized in internal medicine.
- Implemented early antibiotic discontinuation after 3 days of beta-lactam therapy for clinically stable patients.
Main Results:
- 49 patients included; median age 72; median antibiotic duration 4 days.
- 30-day cure rate was 88%.
- Immunocompromised patients showed a higher failure rate with short antibiotic courses (38% vs. 14%).
Conclusions:
- Early antibiotic discontinuation after 3 days is safe and feasible for immunocompetent pneumonia patients.
- The strategy is easily implementable in internal medicine wards.
- Further research is needed for optimizing treatment in immunocompromised populations.
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