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Current Treatment Options in Pediatrics
Erschienen in:

01.12.2023 | Pediatric Infectious Disease (M Mitchell and F Zhu, Section Editors)

The Current Evidence for Short-Course Antibiotics in Pediatric Community Acquired Pneumonia

verfasst von: Khaled Al-zubaidi, Michelle Mitchell

Erschienen in: Current Treatment Options in Pediatrics | Ausgabe 4/2023

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Abstract

Purpose of the review

Respiratory infections, including community acquired pneumonia (CAP), are considered among the most common indications of antibiotic therapy. However, there is no clear consensus regarding what is a safe and effective duration of antibiotic treatment course for CAP. Additionally, antibiotic overuse is considered a major contributor to antibiotic resistance and adverse drug events.

Recent findings

Recent guidelines published by medical societies in developed countries tend to recommend antibiotic treatment durations up to 10 days. However, many recent studies in both developed and developing countries, where they tend to treat with shorter courses of 3–5 days, have demonstrated that a short antibiotic course (5 days) is non-inferior to the current recommended course in most developed countries.

Summary

This review article summarizes the current clinical practice guidelines and reviews recent scientific evidence supporting shorter antibiotic courses among pediatric patients with uncomplicated CAP.
Literatur
1.
2.
Tamma PD, Hsu AJ. Defining the role of novel beta-lactam agents that target carbapenem-resistant gram-negative organisms. J Pediatric Infect Dis Soc. 2019;8(3):251–60.CrossRefPubMedPubMedCentral
3.
Hecker MT, et al. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med. 2003;163(8):972–8.CrossRefPubMed
4.
Chung A, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ. 2007;335(7617):429.CrossRefPubMedPubMedCentral
5.
Teshome BF, et al. Duration of exposure to antipseudomonal beta-lactam antibiotics in the critically ill and development of new resistance. Pharmacotherapy. 2019;39(3):261–70.CrossRefPubMedPubMedCentral
6.
Centers for Disease Control and Prevention (U.S.). Antibiotic resistance threats in the United States, 2019. 2019.
7.
8.
Fleming-Dutra KE, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. Jama. 2016;315(17):1864–73.CrossRefPubMed
9.
Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6:47.CrossRefPubMedPubMedCentral
10.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229–41.CrossRefPubMedPubMedCentral
11.
Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. Bmj. 2019;364:k5092.CrossRefPubMedPubMedCentral
12.
Wald-Dickler N, Spellberg B. Short-course antibiotic therapy-replacing constantine units with "Shorter Is Better". Clin Infect Dis. 2019;69(9):1476–9.CrossRefPubMedPubMedCentral
13.
Vaughn VM, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study. Ann Intern Med. 2019;171(3):153–63.CrossRefPubMed
14.
Mustafa ZU, Khan AH, Salman M, Syed Sulaiman SA, Godman B. Antimicrobial utilization among neonates and children: a multicenter point prevalence study from leading children's hospitals in Punjab, Pakistan. Antibiotics (Basel, Switzerland). 2022;11(8):1056.
15.
16.
Thompson PL, et al. Changes in clinical indications for community antibiotic prescribing for children in the UK from 1996 to 2006: will the new NICE prescribing guidance on upper respiratory tract infections just be ignored? Arch Dis Child. 2009;94(5):337–40.CrossRefPubMed
17.
Hersh AL, et al. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053–61.CrossRefPubMed
18.
Sie A, et al. Indication for antibiotic prescription among children attending primary healthcare services in Rural Burkina Faso. Clin Infect Dis. 2021;73(7):1288–91.CrossRefPubMedPubMedCentral
19.
Utah Medicaid Drug report Septemeber. Antibiotic utilization in pediatric patients. In: 2017, University of Utah College of Pharmacy. L.S.Skaggs: Pharmacy Institute; 2017.
20.
Bradley JS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25–76.CrossRefPubMed
21.
Harris M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66(Suppl 2):ii1–23.CrossRefPubMed
22.
Le Saux N, et al. Uncomplicated pneumonia in healthy Canadian children and youth: practice points for management. Paediatr Child Health. 2015;20(8):441–50.CrossRefPubMedPubMedCentral
23.
Infants and children: Acute management of community acquired pneumonia. NSW Health; 2018. Contract No.: GL2018_007.
24.
WHO. Revised WHO classification and treatment of childhood pneumonia at health facilities. Geneva: World Health Organization; 2014.
25.
Pakistan Multicentre Amoxycillin Short Course Therapy (MASCOT) pneumonia study group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet (London, England). 2002;360(9336):835–41.
26.
Agarwal G, et al. Three day versus five day treatment with amoxicillin for non-severe pneumonia in young children: a multicentre randomised controlled trial. BMJ. 2004;328(7443):791.CrossRefPubMed
27.
• Bielicki JA, et al. Effect of amoxicillin dose and treatment duration on the need for antibiotic re-treatment in children with community-acquired pneumonia: the CAP-IT Randomized Clinical Trial. JAMA. 2021;326(17):1713–24. This study conducted in the UK in 2021 showed the 3-day antibiotic course is non-inferior to a longer course (7-day)for the treatment of children with CAP in outpatient settings. Additionally, this study demonstrated that low-dose amoxicillin is non-inferior to higher-dose in CAP treatment. The study findings support the use of short antibiotic course in outpatient settingsCrossRefPubMedPubMedCentral
28.
• Williams DJ, et al. Short- vs standard-course outpatient antibiotic therapy for community-acquired pneumonia in children: the SCOUT-CAP randomized clinical trial. JAMA Pediatr. 2022;176(3):253–61. This DB-RCT done in the US and published in 2022, showed that clinical response and ADE are similar in both children treated for CAP with a 5-day or 10-day antibiotics courseCrossRefPubMed
29.
Greenberg D, et al. Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: a double-blind, randomized, placebo-controlled trial. Pediatr Infect Dis J. 2014;33(2):136–42.CrossRefPubMed
30.
• Pernica JM, et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia: the SAFER randomized clinical trial. JAMA Pediatr. 2021;175(5):475–82. This Canadian study published in 2021 used both clinical and radiological findings as a part of the inclusion criteria. Despite the strict inclusion criteria, the study showed that short antibiotics course is comparable to the standard of care treatment of children with CAP in outpatient settingsCrossRefPubMed
31.
• Same RG, et al. The association of antibiotic duration with successful treatment of community-acquired pneumonia in children. J Pediatric Infect Dis Soc. 2021;10(3):267–73. This retrospective study reviewed the management of children with uncomplicated CAP in a tertiary center. The study findings showed that a short antibiotic course is not associated with an increase in the 30-day treatment failure rateCrossRefPubMed
32.
• McCallum GB, et al. Extended versus standard antibiotic course duration in children <5 years of age hospitalized with community-acquired pneumonia in high-risk settings: four-week outcomes of a multicenter, double-blind, parallel, superiority randomized controlled trial. Pediatr Infect Dis J. 2022;41(7):549–55. This recent multicenter, multinational DB-RCT demonstrated that the clinical cure rate at 4 weeks is not statistically different between hospitalized children with uncomplicated CAP receiving extended (13-14) or standard (5-6) antibiotics coursesCrossRefPubMed
33.
Metlay JP, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–67.CrossRefPubMedPubMedCentral
34.
Lipshaw MJ, Eckerle M, Florin TA, Crotty EJ, Lipscomb J, et al. Antibiotic use and outcomes in children in the emergency department with suspected pneumonia. Pediatrics. 2020;145(4):e20193138.
35.
36.
Ginsburg AS, et al. Placebo vs amoxicillin for nonsevere fast-breathing pneumonia in Malawian children aged 2 to 59 months: a double-blind, randomized clinical noninferiority trial. JAMA Pediatr. 2019;173(1):21–8.CrossRefPubMed
37.
38.
• Ginsburg AS, et al. Amoxicillin for 3 or 5 Days for Chest-Indrawing Pneumonia in Malawian Children. N Engl J Med. 2020;383(1):13–23. This is a recent study that took place in Malawi (an under-resource, developing country) and showed similar findings to studies done later in high-resource, developed countries
39.
• Gao Y, Liu M, Yang K, Zhao Y, Tian J, Pernica JM, et al. Shorter versus longer-term antibiotic treatments for community-acquired pneumonia in children: a meta-analysis. Pediatrics. 2023;151(6):e2022060097. This is a recently published metanalysis, which included sixteen prospective trials done in outpatient settings in the last 3-decades. The metanalysis showed that clinician should priortize short antibiotic duration in management of children with CAP in outpatients
Metadaten
Titel
The Current Evidence for Short-Course Antibiotics in Pediatric Community Acquired Pneumonia
verfasst von
Khaled Al-zubaidi
Michelle Mitchell
Publikationsdatum
01.12.2023
Verlag
Springer International Publishing
Erschienen in
Current Treatment Options in Pediatrics / Ausgabe 4/2023
Elektronische ISSN: 2198-6088
DOI
https://doi.org/10.1007/s40746-023-00285-y

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