Abstract
BackgroundThe optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP.MethodsThis was a multicenter study assessing complications developed during 1 year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year was analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30.ResultsA total of 312 patients were included, 150 in the control group and 162 in the intervention group. Ninety day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p = 0.94), new admissions (p = 0.84) or cardiovascular events (p = 0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p = 0.29; PCT p = 0.44; proADM p = 0.52).ConclusionsReducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.
Highlights
The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established
The optimal duration of antibiotic treatment in community acquired pneumonia (CAP) is not well established: discrepancies exist between the different guidelines published to date [1,2,3]
Our working group published the positive results [18] of a clinical trial designed to validate the IDSA / ATS criteria on the duration of antibiotic treatment in patients admitted for CAP
Summary
The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. The optimal duration of antibiotic treatment in community acquired pneumonia (CAP) is not well established: discrepancies exist between the different guidelines published to date [1,2,3]. In 2007, IDSA / ATS included a minimum treatment of 5 days, The negative impact of the overuse of antibiotics is well known In this regard, an increase in nasopharyngeal carriers of penicillin-resistant Streptococcus pneumoniae has been observed with the use of low-dose beta-lactams for more than 5 days in children. When evaluating only the most severe patients, mortality was 2.2% in the group with a shorter regimen compared to 4.7% in the long regimen group
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