Short-course vs long-course antibiotic treatment for paediatric patients with uncomplicated community-acquired pneumonia.

INTRODUCTION

The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) in paediatrics remains unclear. Recent studies suggest that a 5-day course of amoxicillin could be an effective and safe option. This regimen was implemented in our hospital in 2023. The aim of this study is to compare its clinical efficacy with the longer course previously used.

METHODS

A single-centre quasi-experimental study with historical controls was conducted. Two groups of patients aged 6 months to <18 years with a clinical and radiological diagnosis of uncomplicated CAP in the emergency department treated as outpatients with amoxicillin were included: Group 1 (January-June 2022, long-course [7-10 days]) and Group 2 (January-June 2024, short-course [5 days]). Treatment failure (hospital admission, antibiotic retreatment, or relapse within 30 days after treatment completion) was compared between both groups.

RESULTS

A total of 491 patients were included: 194 in Group 1 and 297 in Group 2. Treatment failure occurred in 17 patients (3.7%; 95% CI 2.2-5.5%): 2.1% in Group 1 vs 4.4% in Group 2 (P = .170). The main cause in both groups was relapse (100% [4/4] in Group 1 vs 61.5% [8/13] in Group 2; P = .410). In five patients from Group 2, antibiotic therapy was modified: in three cases a different antibiotic was prescribed, and in two cases amoxicillin was extended. No patients required hospital admission.

CONCLUSIONS

A short 5-day course of amoxicillin is as effective as a longer course for uncomplicated CAP in children, with low treatment failure rates.