Is extended superior to standard antibiotic course in children hospitalized with CAP?

An extended antibiotic course appears to be not any better than a standard course at achieving clinical cure among children hospitalized with community-acquired pneumonia (CAP) and at risk of chronic respiratory illnesses at 4 weeks, a study has shown.

“As part of a larger study, we determined whether an extended antibiotic course is superior to a standard course for achieving clinical cure at 4 weeks in children 3 months to ≤5 years old hospitalized with CAP,” the authors said.

This multinational, double-blind, superiority randomized controlled trial was conducted on children hospitalized with uncomplicated, radiographic-confirmed CAP in Malaysia, Australia, and New Zealand. Participants received 1‒3 days of intravenous antibiotics followed by 3 days of oral amoxicillin-clavulanate (80 mg/kg, amoxicillin component, divided twice daily) and were then randomized to extended (13‒14 days duration) or standard (5‒6 days) antibiotics.

Clinical cure (complete resolution of respiratory symptoms/signs) 4 weeks postenrolment was the primary outcome. Secondary ones included adverse events, nasopharyngeal bacterial pathogens, and antimicrobial resistance at 4 weeks.

A total of 372 children were identified, of which 324 met the eligibility criteria. Intention-to-treat analysis revealed similar cure rates between groups (extended course: n=127/163, 77.9 percent; standard course: n=131/161, 81.3 percent; relative risk, 0.96, 95 percent confidence interval [CI], 0.86‒1.07).

In addition, no significant between-group differences were observed in adverse events (extended course: n=43/163, 26.4 percent; standard course: n=32/161, 19.9 percent) or nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus or antimicrobial resistance.

“Additional research will identify if an extended course provides longer-term benefits,” the authors said.