NEW YORK (Reuters Health) – A five-day course high-dose amoxicillin works as well as a standard care 10 day course for previously healthy children with community-acquired pneumonia who do not require hospital admission, according to results of the SAFER trial.
“I think that doctors have long suspected that we didn’t need long antibiotic treatment courses for children with typical community-acquired pneumonia, and our clinical trial confirms this,” Dr. Jeffrey Pernica, chief of the division of infectious diseases and associate professor of pediatrics, McMaster University, Hamilton, Ontario, Canada, told Reuters Health by email.
The SAFER (Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections) study enrolled 281 children aged six months to 10 years (median age, 2.6 years) with fever within 48 hours, respiratory symptoms, chest radiography findings consistent with pneumonia and a primary diagnosis of pneumonia. None of them required hospitalization or had comorbidities that would predispose them to severe disease and/or pneumonia of unusual origin, or previous beta-lactam antibiotic therapy.
The children were randomly allocated to five days of high-dose amoxicillin therapy followed by five days of placebo (intervention group) or five days of high-dose amoxicillin followed by a different formulation of five days of high-dose amoxicillin (control group).
According to the JAMA Pediatrics report, children treated with the five-day course of antibiotic therapy had comparable rates of clinical cure at 14 to 21 days after enrollment compared with their peers given the standard 10-day course (85.7% vs 84.1%).
“One clinical trial is never definitive,” Dr. Pernica told Reuters Health, “and I would welcome additional studies, but, at the current time, I think that the evidence we have would suggest that five days of antibiotics is preferable to 10 days of antibiotics for children with community-acquired pneumonia.”
The SAFER trial findings are in line with randomized controlled trials of short-course antibiotic treatment for the treatment of adults with CAP.
“In this era of widespread antimicrobial resistance, which may well worsen as a result of the coronavirus disease 2019 pandemic, it is important that antibiotic treatment durations for common infections are as short as possible and based on evidence rather than custom,” the authors note in their article.
“Clinical practice guidelines should consider recommending five days of amoxicillin for pediatric pneumonia management in accordance with antimicrobial stewardship principles,” they conclude.
This study was supported by Hamilton Health Sciences (New Investigator Fund and an Early Career Award), the PSI Foundation, and Pediatric Emergency Research Canada. Dr. Pernica reported receiving grant funding from bioMerieux SA for a study of enteropathogen diagnostics for children with severe gastroenteritis in Botswana outside the submitted work.
SOURCE: https://bit.ly/2MWDIlc JAMA Pediatrics, online March 8, 2021.
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