WASHINGTON — Three days of antibiotics were as effective as 8 days for curing or substantially improving patients with mild to moderate, community-acquired pneumonia in a controlled study with 119 patients done in the Netherlands.
Patients were randomized to ongoing antibiotic treatment or placebo if they showed substantial improvement following 3 days of IV amoxicillin, Rachida El Moussaoui, M.D., said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
“The results apply to patients with mild to moderately severe community-acquired pneumonia, which is about 60%-80% of patients who are hospitalized for community-acquired pneumonia,” said Dr. El Moussaoui, an infectious diseases physician at the University of Amsterdam. In addition, the results apply only to patients who substantially improve after their first 3 days of IV amoxicillin. In the study, about 75% of treated patients met this criterion.
The study was done at nine hospitals in the Netherlands during 2000-2003, and enrolled patients aged 18 years or older with clinical signs of pneumonia, radiologic evidence of a new lung infiltrate, and a pneumonia severity score of no more than 110. All patients began intravenous therapy with amoxicillin and were reevaluated after 3 days. Patients were then randomized if their temperature was lower than 38 °C and if their scores for several symptoms, including dyspnea, cough, and coughing up sputum, had improved by 2 or more points. They were then treated with either oral amoxicillin or placebo for an additional 5 days.
The study's primary end point was clinical success and pneumonia severity score at 10 days after the start of treatment. Based on these criteria, 50 of the 56 patients (89%) who received 3 days of active treatment were cured or significantly improved, compared with 56 of 63 (89%) patients in the group receiving 8 days of treatment, Dr. El Moussaoui reported at the conference, sponsored by the American Society for Microbiology.
The two groups also showed very similar rates of bacteriologic cure and radiologic cure. The study's secondary end point was clinical success at 28 days after the start of treatment, and was achieved by 84% of patients who had 3 days of treatment and by 78% who received 8 days of treatment.
The median hospital length of stay was 6 days in the 3-day group and 7 days in the 8-day group.
If a strategy of 3 days of antibiotic treatment were applied to similar pneumonia patients in routine practice, it could lead to a drop in antibiotic use and might help contain antibiotic resistance, Dr. El Moussaoui said.
Kevin Foley, research/Forhad S. Hossain, Design