Clinical Question

Are children with community-acquired pneumonia (CAP) better off with five days or 10 days of antibiotics?

Bottom Line

Children who clinically improve after five days of antibiotics for CAP do well whether they stop treatment or receive an additional five days of therapy. (Level of Evidence = 1b)

Synopsis

The study took place in multiple settings: outpatient clinics, urgent care centers, and emergency departments. The researchers enrolled children six to 71 months of age with clinically diagnosed uncomplicated CAP. When enrolled, the children had already been treated with three to five days of amoxicillin, amoxicillin/clavulanate, or cefdinir (Omnicef), independent of study protocol. The children were doing well at the time of enrollment (i.e., afebrile, not tachypneic, and no severe cough). After completion of five days of initial therapy, the children were then randomized to receive five days of placebo (n = 189) or an additional five days of the original antibiotic (n = 191). The researchers evaluated the children serially until 25 days after enrollment using a composite scale (based on clinical response, resolution of symptoms, and adverse effects) that they adjusted for duration of antibiotics. There were no significant differences in any of the individual components of the composite. However, the authors report that when adjusted for duration, five days of antibiotics was associated with a greater probability of a desirable outcome (0.69; 95% CI, 0.63 to 0.75) than 10 days of therapy. A subset of 171 children agreed to have throat swabs 19 to 25 days after enrollment to test for antibiotic resistant genes; the number of these was significantly lower in the children treated for five days. The authors did not report actual bacterial resistance.