Duration of Antibiotic Treatment in Community-Acquired Pneumonia

Abstract

The optimal duration of antibiotic treatment in communityacquired pneumonia (CAP) has not been completely established, and there are discrepancies even between various clinical guidelines published to date. The British Thoracic Society1 recommends 7 days of antibiotic treatment in patients with uncomplicated mild to moderate CAP. In 2011, the ERS2 published guidelines recommending that treatment should not exceed 8 days in responding patients defined by clinical stability criteria. However, as far back as 2007, the IDSA/ATS3 recommended a minimum treatment of 5 days, providing that the patient remained a febrile for 48–72 h, with no more than 1 sign of clinical instability. Efforts to cut back on widespread antibiotic use have been associated with multiple benefits, such as a decrease in microbial resistance, fewer adverse effects, and improved treatment adherence. The use of low-dose and long-duration (>5 days) betalactamics is associated with an increase in pharyngeal carriage of penicillin-resistant Streptococcus pneumoniae.4 Despite this, reducing the duration of antibiotic treatment in CAP can be complicated in routine clinical practice. In this respect, Moussaoui et al.5 conducted a clinical trial in 186 patients with CAP and a pneumonia severity score (PSI) of less than 110 points, who were given amoxicillin. In patients who presented an initial improvement after 72 h, 3 days of amoxicillin was equivalent to continuing the treatment for 8 days. Clinical cure was achieved after 10 days in 93% of cases in both groups. In view of the concentration-dependent bactericide activity and prolonged post-antibiotic effect of quinolones, it is logical to presume that by increasing the dose, and therefore the peak concentration and area under the curve, the duration of antibiotic treatment can be reduced without affecting efficacy. Dunbar et al.6 compared a 5-day course of levofloxacin 750 mg versus a 10-day course of 500 mg of the same antibiotic in patients with CAP PSI I–IV. He found that both were at least equally effective, and that fever was resolved earlier in the first group. Macrolides are known to have a long half-life and excellent lung penetration, which undoubtedly facilitates their use in short