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Comparison of Short- vs Long-Course Antibiotic Therapy for Children With Tracheitis Associated With an Artificial
Tracy N Zembles1, Rainer G Gedeit2, Martin K Wakeham2
1Department of Enterprise Safety; Children's Wisconsin, Milwaukee, WI, USA.
Insights
Shorter antibiotic courses for tracheitis (5 days) are as effective as longer courses (7+ days). Limiting antibiotic duration does not worsen patient outcomes, supporting shorter treatment durations.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Antimicrobial stewardship
Background:
- Tracheitis treatment duration is a key area for antimicrobial stewardship.
- Optimizing antibiotic use is crucial to combat resistance and improve patient outcomes.
Purpose of the Study:
- To compare outcomes of short-course versus long-course antibiotic therapy for pediatric tracheitis.
- To evaluate the impact of antibiotic duration on re-treatment, new infections, and mortality.
Main Methods:
- Retrospective cohort study of pediatric intensive care unit patients with tracheitis requiring antibiotics.
- Comparison of outcomes between patients receiving ≤6 days (short course) versus ≥7 days (long course) of antibiotics.
- Analysis of re-treatment rates, new pneumonia, and multi-drug resistant organism development.
Main Results:
- 95 patients analyzed: 42 (short course, median 5 days) and 53 (long course, median 9 days).
- No statistically significant difference in composite outcomes (re-treatment/pneumonia) or 30-day mortality between groups.
- Antibiotic duration did not impact the development of subsequent multi-drug resistant organisms.
Conclusions:
- Short-course antibiotic therapy (≤6 days) for tracheitis is not associated with worse outcomes compared to longer courses.
- A 5-day antibiotic duration for pediatric tracheitis is recommended, aligning with antimicrobial stewardship principles.
Objective:
Limiting antibiotic days for treatment of tracheitis to the shortest, most effective duration is an important antimicrobial stewardship endeavor. The objective was to compare outcomes between patients who received a short course of antibiotics to those receiving a longer course.
Methods:
This is a retrospective, cohort evaluation of patients admitted to the pediatric intensive care unit with an artificial airway and prescribed a course of antibiotics for at least 3 days for tracheitis. We compared the rate of re-treatment of tracheitis or development of new pneumonia requiring antibiotics within 10 days of completing therapy between patients receiving a short course (≤ 6 days) or long course (≥ 7 days) of antibiotics for tracheitis. We also compared the rate of developing a subsequent multi-drug resistant organism within 30 days of completing therapy between groups.
Results:
A total of 95 patients were included; 42 (44%) patients received short (median 5 days) duration antibiotic therapy and 53 (56%) patients received long (median 9 days) duration. Duration of therapy did not statistically impact the composite of need for re-treatment of tracheitis or development of pneumonia within 10 days or all-cause mortality within 30 days of completing antibiotics.
Conclusions:
Shorter courses do not have worse outcomes compared to longer courses. Pediatric providers should be encouraged to limit treatment duration for tracheitis to 5 days.
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