Shortened Antibiotic Treatment for 5 Days in Patients Hospitalized with Community-Acquired Pneumonia
Speaker: Dr. Simone Bastrop Israelsen, Denmark
Key Highlights
Introduction:
Community-acquired pneumonia (CAP) is a major global health burden, particularly in elderly populations and contributes significantly to hospitalizations and mortality. Since the incidence of CAP is high, it is a leading driver of antibiotic use. Optimizing the duration of antibiotic use is crucial for antibiotic stewardship in order to reduce resistance and adverse effects. Already existing studies suggest that shorter antibiotic courses are effective in stable patients, but most of these studies assessed short-term clinical cure and not mortality which shows that there is limited information about the safety of shorter duration courses.
Main Objective:
The main objective of the study was to determine whether a 5-day course of antibiotics is non-inferior to a 7-day course in hospitalized adults with community-acquired pneumonia (CAP) who have achieved early clinical stability, using 90-day all-cause mortality as the primary endpoint.
Method:
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It was a multicenter, 1:1 randomized, open-label, non-inferiority trial that included 395 patients.
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The patients were randomized into 2 groups: 131 in 5-day antibiotic treatment and 173 in 7-day antibiotic treatment.
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Adults that were hospitalized with radiologically confirmed CAP and who achieved clinical stability within 3-5 days of treatment were included in the study.
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The stability criteria included the following measure for vital signs:
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BP ≥90 mmHg
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HR ≤100 bpm
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RR ≤24/min
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Oxygen saturation ≥90%,
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Temperature ≤38°C.
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Patients experiencing immunosuppression, extra-pulmonary infections, complicated pneumonia, or ICU admission were excluded from the study.
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Primary Endpoints included 90-day all-cause mortality and the secondary endpoints included 30-day mortality, 90-day readmissions, antibiotic-related adverse events, serious adverse events.
Results:
The comparison of the primary outcome and the secondary outcomes in the intent-to-treat group are given in the tables below
|
Primary Outcome |
5-Day Group |
7-Day Group |
Comments |
|
90-day Mortality |
3.1% |
2.0% |
Risk difference: 1.1% (95% CI: −2.0% to 4.1%) |
|
|
|
|
Non-inferiority confirmed (margin: 6%) |
|
Secondary Outcome |
5-Day Group |
7-Day Group |
Comments |
|
30-day Mortality |
1% (2 patients) |
1% (2 patients) |
Identical between groups |
|
90 days Readmission |
23.5% |
21.3% |
Not statistically analysed |
|
Antibiotic-Related Adverse Events |
14.8% |
16.2% |
Similar between groups |
|
Serious Adverse Events |
25.0% |
24.9% |
No difference reported |
Conclusion:
It was concluded that 5-day antibiotic therapy is non-inferior to 7-day therapy in CAP patients. This in turn ultimately promotes shorter, patient tailored regimens. Broader adoption of evidence based practices should be encouraged in pneumonia care to optimize outcomes and antibiotic use.
ESCMID Global, 11–15 April 2025, Vienna
