Short-course vs long-course antibiotic treatment for paediatric patients with uncomplicated community-acquired
Patricia Diego Vall1, Susanna Hernández Bou2, María Ríos Barnes3
1Área de Urgencias Pediátricas, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain.
Insights
A 5-day course of amoxicillin is as effective as a longer treatment for pediatric community-acquired pneumonia (CAP). This shorter antibiotic regimen demonstrates low treatment failure rates in children with uncomplicated CAP.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Evidence-based medicine
Background:
- Optimal antibiotic duration for pediatric community-acquired pneumonia (CAP) is not well-defined.
- Recent evidence suggests a 5-day amoxicillin course may be effective and safe.
- This study evaluates a hospital's implementation of a 5-day amoxicillin regimen for CAP.
Purpose of the Study:
- To compare the clinical efficacy of a 5-day amoxicillin course versus a 7-10 day course for uncomplicated pediatric CAP.
- To assess treatment failure rates, including hospital admission, retreatment, or relapse.
- To evaluate the safety and effectiveness of shorter antibiotic durations in pediatric CAP management.
Main Methods:
- A single-centre, quasi-experimental study with historical controls.
- Inclusion of pediatric patients (6 months to <18 years) with uncomplicated CAP treated as outpatients.
- Comparison of treatment failure between a short-course (5-day) amoxicillin group and a long-course (7-10 day) group.
Main Results:
- A total of 491 patients were analyzed (194 long-course, 297 short-course).
- Overall treatment failure rate was 3.7%, with no significant difference between groups (2.1% long-course vs. 4.4% short-course, P=0.170).
- Relapse was the primary cause of failure in both groups; no patients required hospital admission.
Conclusions:
- A 5-day course of amoxicillin is non-inferior to a longer course for uncomplicated pediatric CAP.
- The short-course regimen demonstrates low treatment failure rates and is a viable clinical option.
- This supports the use of shorter antibiotic durations in pediatric CAP management.
Introduction:
The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) in paediatrics remains unclear. Recent studies suggest that a 5-day course of amoxicillin could be an effective and safe option. This regimen was implemented in our hospital in 2023. The aim of this study is to compare its clinical efficacy with the longer course previously used.
Methods:
A single-centre quasi-experimental study with historical controls was conducted. Two groups of patients aged 6 months to <18 years with a clinical and radiological diagnosis of uncomplicated CAP in the emergency department treated as outpatients with amoxicillin were included: Group 1 (January-June 2022, long-course [7-10 days]) and Group 2 (January-June 2024, short-course [5 days]). Treatment failure (hospital admission, antibiotic retreatment, or relapse within 30 days after treatment completion) was compared between both groups.
Results:
A total of 491 patients were included: 194 in Group 1 and 297 in Group 2. Treatment failure occurred in 17 patients (3.7%; 95% CI 2.2-5.5%): 2.1% in Group 1 vs 4.4% in Group 2 (P = .170). The main cause in both groups was relapse (100% [4/4] in Group 1 vs 61.5% [8/13] in Group 2; P = .410). In five patients from Group 2, antibiotic therapy was modified: in three cases a different antibiotic was prescribed, and in two cases amoxicillin was extended. No patients required hospital admission.
Conclusions:
A short 5-day course of amoxicillin is as effective as a longer course for uncomplicated CAP in children, with low treatment failure rates.
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