Impact of reducing the duration of antibiotic treatment on the long-term prognosis of community acquired pneumonia
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(2020) 20:261
RESEARCH ARTICLE
Open Access
Impact of reducing the duration of antibiotic treatment on the long-term prognosis of community acquired pneumonia Ane Uranga MD1*, Amaia Artaraz MD1, Amaia Bilbao MD2,3,4, Jose María Quintana MD3,4,5, Ignacio Arriaga MD6, Maider Intxausti MD6, Jose Luis Lobo MD7, Julia Amaranta García MD7, Jesus Camino MD8 and Pedro Pablo España MD1
Abstract Background: The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods: This was a multicenter study assessing complications developed during 1 year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year was analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results: A total of 312 patients were included, 150 in the control group and 162 in the intervention group. Ninety day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p = 0.94), new admissions (p = 0.84) or cardiovascular events (p = 0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p = 0.29; PCT p = 0.44; proADM p = 0.52). Conclusions: Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications. Keywords: Pneumonia, Duration, Antibiotic, Prognosis, Complications
Background The optimal duration of antibiotic treatment in community acquired pneumonia (CAP) is not well established: discrepancies exist between the different guidelines published to date [1–3]. In 2007, IDSA / * Correspondence: [email protected] 1 Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960 Galdakao, Bizkaia, Spain Full list of author information is available at the end of the article
ATS included a minimum treatment of 5 days, provided the patient remains free of fever for 48–72 h and without more than one criterion of clinical instability [4]. Recently published updated guidelines keep the same recommendation [5]. The negative impact of the overuse of antibiotics is well known. In this regard, an increase in nasopharyngeal carriers of penicillin-resistant Streptococcus pneumoniae has been observed with the use of low-dose
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adapta
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