TY - JOUR

T1 - Short-course versus long-course antibiotic treatment for community-acquired pneumonia

T2 - a literature review

AU - Gundersen, Kamilla Møller

AU - Jensen, Jette Nygaard

AU - Bjerrum, Lars

AU - Hansen, Malene Plejdrup

N1 - This article is protected by copyright. All rights reserved.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: It is well known that antibiotic use is the main driver for the increasing problems with resistant bacteria. Consequently, some countries have recommended shortening the duration of antibiotic treatment of community-acquired pneumonia (CAP). The aim of this study was to investigate if the effectiveness of a short-course antibiotic is comparable to a longer course of antibiotics in adults with CAP and to assess if the duration of an antibiotic course influences the development of resistant bacteria.METHODS: A literature search was performed in PubMed and EMBASE. We included randomised, controlled trials (RCTs) comparing clinical success, microbiological efficacy, patient safety and antibiotic resistance in a short-course (5 days) versus a long-course antibiotic treatment (7+ days) for CAP.RESULTS: Six RCTs were included. Clinical success rates were 87-95% in patients treated with short-course antibiotics and 88-94% in patients treated with a longer course. Eradication of pathogenic bacteria was found to be 100% and 95-100% in patients treated with short-course and long-course antibiotics, respectively. No significant differences in adverse events were reported. However, none of the trials reported on the impact on the development of resistant bacteria.CONCLUSION: Only few trials were included in this review and more RCTs are highly needed to be able to provide solid evidence for optimal treatment durations for patients diagnosed with CAP. Importantly, fluoroquinolones were often the drug of choice, and trials testing beta-lactam antibiotics, which are the type of antibiotics most often used in many European countries, should be aimed for in near future. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: It is well known that antibiotic use is the main driver for the increasing problems with resistant bacteria. Consequently, some countries have recommended shortening the duration of antibiotic treatment of community-acquired pneumonia (CAP). The aim of this study was to investigate if the effectiveness of a short-course antibiotic is comparable to a longer course of antibiotics in adults with CAP and to assess if the duration of an antibiotic course influences the development of resistant bacteria.METHODS: A literature search was performed in PubMed and EMBASE. We included randomised, controlled trials (RCTs) comparing clinical success, microbiological efficacy, patient safety and antibiotic resistance in a short-course (5 days) versus a long-course antibiotic treatment (7+ days) for CAP.RESULTS: Six RCTs were included. Clinical success rates were 87-95% in patients treated with short-course antibiotics and 88-94% in patients treated with a longer course. Eradication of pathogenic bacteria was found to be 100% and 95-100% in patients treated with short-course and long-course antibiotics, respectively. No significant differences in adverse events were reported. However, none of the trials reported on the impact on the development of resistant bacteria.CONCLUSION: Only few trials were included in this review and more RCTs are highly needed to be able to provide solid evidence for optimal treatment durations for patients diagnosed with CAP. Importantly, fluoroquinolones were often the drug of choice, and trials testing beta-lactam antibiotics, which are the type of antibiotics most often used in many European countries, should be aimed for in near future. This article is protected by copyright. All rights reserved.

U2 - 10.1111/bcpt.13205

DO - 10.1111/bcpt.13205

M3 - Journal article

C2 - 30694600

VL - 124

SP - 550

EP - 559

JO - Basic and Clinical Pharmacology and Toxicology

JF - Basic and Clinical Pharmacology and Toxicology

SN - 1742-7835

IS - 5

ER -