Short-course antibiotic therapy enough for paediatric outpatient CAP

Children with community-acquired pneumonia (CAP) who received a shorter course of antibiotic therapy were more likely to achieve a more desirable outcome than those on a standard-course regimen, according to the SCOUT-CAP* trial presented at ID Week 2020.

“The explicit a priori assumption in this analysis is that, given an equivalent clinical response, fewer days of antibiotics are more desirable because they involve decreased antibiotic exposure, which may also result in decreased antibiotic resistance,” according to study investigator Professor Charles Huskins from Mayo Clinic College of Medicine and Science in Rochester, Minnesota, US.

The researchers conducted a double-blind, placebo-controlled, superiority trial involving 385 children with CAP (aged 6–71 months) whose condition had improved within 3–5 days after initial antibiotic therapy. Participants were then randomized in a 1:1 ratio to receive an additional 5-day course of either the same prescribed antibiotic (standard course, 10–11 days) or matching placebo (short course, 5 days). The primary endpoint of the study was the DOOR** outcome, which consisted of several components such as Ordinal Clinical Response (OCR)*** and the documented days of antibiotic treatment, on days 11–14. [ID Week 2020, abstract 175]

Children who received short-course antibiotic treatment achieved a 69 percent probability of a more desirable outcome (95 percent confidence interval, 63.0–72.0; p<0.001) than those on standard-course treatment. “[The results] clearly favour[ed] the short-course treatment arm,” noted Huskins.

In the OCR analysis, a 48 percent probability of a more desirable outcome was observed in the short-course treatment arm, though there was no significant difference between the two treatment arms.

Overall, majority of the patients in each treatment arm demonstrated an adequate response to CAP treatment with most having no or only mild antibiotic adverse events, Huskins noted.

“[In conclusion, among children with CAP demonstrating initial clinical improvement with outpatient therapy, … short-course therapy was superior in our a priori defined outcome that incorporated decreased antibiotic exposure, … [which also] resulted in increased convenience and decreased cost,” Huskins said.

“We also noted that this is the first randomized clinical trial to use DOOR for both the design and analysis of the study, and that DOOR may be useful for future studies of antimicrobial stewardship interventions or other studies that examine combined benefits and risks of antimicrobial therapy,” he added.

*SCOUT-CAP: Trial to evaluate beta-lactam antimicrobial therapy of community-acquired pneumonia in children

**DOOR: Desirability of Outcome Ranking

***OCR: Composed of response to CAP treatment and the occurrence and severity of antibiotic adverse events