Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With
Hing C Kok1,2, Gabrielle B McCallum1, Stephanie T Yerkovich1,3
1From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Insights
Extended antibiotic courses for pediatric community-acquired pneumonia (CAP) did not improve long-term respiratory outcomes in high-risk children. Standard antibiotic durations are sufficient for managing CAP and preventing chronic respiratory issues.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Clinical Trials
Background:
- Pediatric community-acquired pneumonia (CAP) can lead to persistent respiratory problems like bronchiectasis.
- Identifying optimal antibiotic durations is crucial for preventing long-term sequelae in high-risk children.
Purpose of the Study:
- To evaluate if extended antibiotic courses (13-14 days) improve long-term respiratory outcomes compared to standard courses (5-6 days) in hospitalized pediatric CAP patients.
- To assess the impact of antibiotic duration on chronic respiratory symptoms and subsequent lower respiratory infections.
Main Methods:
- A multicenter, double-blind, randomized controlled trial was conducted with children aged 3 months to 5 years.
- Participants received either an extended (13-14 days) or standard (5-6 days) course of amoxicillin-clavulanate.
- Long-term outcomes, including chronic respiratory symptoms and lower respiratory infections, were assessed at 12 and 24 months post-discharge.
Main Results:
- No significant difference in the primary outcome of chronic respiratory symptoms/signs was observed between the extended-course (60%) and standard-course (58%) groups.
- Relative risk for the primary outcome was 1.02 (95% CI: 0.85-1.22).
- Sensitivity analyses confirmed no between-group differences in long-term respiratory outcomes.
Conclusions:
- Extended antibiotic therapy (13-14 days) for pediatric CAP in high-risk populations does not offer improved long-term respiratory benefits over standard durations (5-6 days).
- Current standard antibiotic regimens appear adequate for managing pediatric CAP and preventing chronic respiratory complications.
Background:
Pediatric community-acquired pneumonia (CAP) can lead to long-term respiratory sequelae, including bronchiectasis. We determined if an extended (13-14 days) versus standard (5-6 days) antibiotic course improves long-term outcomes in children hospitalized with CAP from populations at high risk of chronic respiratory disease.
Methods:
We undertook a multicenter, double-blind, superiority, randomized controlled trial involving 7 Australian, New Zealand, and Malaysian hospitals. Children aged 3 months to ≤5 years hospitalized with radiographic-confirmed CAP who received 1-3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, were randomized to either extended-course (8-day oral amoxicillin-clavulanate) or standard-course (8-day oral placebo) arms. Children were reviewed at 12 and 24 months. The primary outcome was children with the composite endpoint of chronic respiratory symptoms/signs (chronic cough at 12 and 24 months; ≥1 subsequent hospitalized acute lower respiratory infection by 24 months; or persistent and/or new chest radiographic signs at 12-months) at 24-months postdischarge, analyzed by intention-to-treat, where children with incomplete follow-up were assumed to have chronic respiratory symptoms/signs ("worst-case" scenario).
Results:
A total of 324 children were randomized [extended-course (n = 163), standard-course (n = 161)]. For our primary outcome, chronic respiratory symptoms/signs occurred in 97/163 (60%) and 94/161 (58%) children in the extended-courses and standard-courses, respectively [relative risk (RR) = 1.02, 95% confidence interval (CI): 0.85-1.22]. Among children where all sub-composite outcomes were known, chronic respiratory symptoms/signs between groups, RR = 1.10, 95% CI: 0.69-1.76 [extended-course = 27/93 (29%) and standard-course = 24/91 (26%)]. Additional sensitivity analyses also revealed no between-group differences.
Conclusion:
Among children from high-risk populations hospitalized with CAP, 13-14 days of antibiotics (versus 5-6 days), did not improve long-term respiratory outcomes.
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