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Shorter Treatment Is Better For Young Children With Community-acquired Pneumonia

January 26, 2022

A five-day course of antibiotics for children with community-acquired pneumonia (CAP) is just as effective as, and actually better than, the standard 10-day treatment, as it could help reduce side effects and limit antibiotic resistance. That’s according to a new study co-authored by a professor at the Yale School of Public Health.

Published in JAMA Pediatrics, the study compared short vs. standard antibiotic treatment strategies for pediatric CAP, a common and serious infection that leads to 1.5 million doctor visits in the U.S. each year.

Clinicians in the U.S. typically treat CAP with a 10-day course of antibiotics. Treatment strategies involving shorter courses of antibiotics have been proposed as a proactive measure to limit antibiotic resistance and decrease possible side effects.

“One of the best ways to prevent antibiotic resistance is to use fewer antibiotics,” said Melinda Pettigrew, Ph.D. ’99, the Anna M.R. Lauder Professor of Epidemiology (Microbial Diseases) at YSPH and a co-author of the study.

“Approximately 1 million courses of antibiotics are prescribed for pneumonia in children and adolescents each year in the U.S. Widespread adoption of a 5-day treatment strategy for pediatric CAP could lead to a reduction of approximately 5 million days of antibiotic use in U.S. children,” Pettigrew said. “This study shows that a shorter antibiotic course for CAP is not only effective, it also significantly reduces the abundance of antibiotic resistance genes in the respiratory tracts of children receiving treatment.”

Antibiotic resistance is considered one of the world’s most urgent public health problems. Antibiotic resistance occurs when bacteria and fungi develop the ability to evade the drugs designed to kill them. Those microbes that are not killed continue to grow and are transmitted in the community and in hospitals. More than 2.8 million antibiotic-resistant infections occur in the U.S. each year, according to the U.S. Centers for Disease Control and Prevention.

The randomized trial was led by members of the Antibacterial Resistance Leadership Group (ARLG), a national team of more than 100 leading experts dedicated to combating the global antibiotic resistance crisis, and researchers at Vanderbilt University Medical Center. Pettigrew, senior associate dean of academic affairs at YSPH, serves on the steering and executive committees of the ARLG.

Previous studies have shown antibiotic treatment shorter than 10 days can work well for childhood pneumonia. The current study is believed to be the first that also looked at the effects of antibiotic duration on the respiratory resistome (i.e., the collection of antibiotic resistance genes in our microbiome). The study design was also innovative in that it incorporated a superiority design with response adjusted for duration of antibiotic risk (RADAR) and desirability of outcome rankings (DOOR). This innovative trial design was pioneered by the ARLG and provides a holistic and patient-centered way to assess the benefits and harms of interventions designed to optimize antibiotic use.

“It’s critical that we minimize the use of unnecessary antibiotics,” said the study’s first author, Derek Williams, M.D., chief of the Division of Pediatric Hospital Medicine at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“Sometimes, this means not using antibiotics at all. In other instances, when antibiotics are required, this means choosing the right antibiotic, at the right dose, and only for as long as necessary to effectively treat the infection,” he said. 

This project was funded, in part, with funds from the National Institute of Allergy and Infectious Diseases (NIAID) to the ARLG (UM1AI104681) and the NIAID Vaccine Treatment and Evaluation Unit at Vanderbilt University Medical Center (HHSN272201300023I).

This article contains content provided by Vanderbilt University Medical Center.

Submitted by Colin Poitras on January 25, 2022