WASHINGTON — Three days of antibiotic treatment were as effective as 8 days for curing or substantially improving patients with mild to moderate, community-acquired pneumonia in a controlled study with 119 patients done in the Netherlands.
Patients were randomized to ongoing antibiotic treatment or placebo if they showed substantial improvement following 3 days of intravenous treatment with amoxicillin, Rachida El Moussaoui, M.D., said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
“The results apply to patients with mild to moderately severe community-acquired pneumonia, which is about 60%-80% of patients who are hospitalized for community-acquired pneumonia,” said Dr. El Moussaoui, an infectious diseases physician at the University of Amsterdam. In addition, the results apply only to patients who substantially improve after their first 3 days of intravenous treatment with amoxicillin. In the study, about 75% of treated patients met this criterion.
“This is an important and well-done study, but it needs validation,” commented Victor L. Yu, M.D., chief of infectious diseases at the Veterans Affairs Medical Center in Pittsburgh. He also questioned whether the finding was applicable to patients with pneumococcal pneumonia, which can be more severe than pneumonia caused by other pathogens.
The study was done at nine hospitals in the Netherlands during 2000-2003 and enrolled patients aged 18 years or older with clinical signs of pneumonia, radiologic evidence of a new lung infiltrate, and a pneumonia severity score of no more than 110. All patients began intravenous therapy with amoxicillin and were reevaluated after 3 days. Patients were then randomized if their temperature was lower than 38 °C and if their scores for several symptoms, including dyspnea, cough, and coughing up sputum, had improved by 2 or more points. They were then treated with either oral amoxicillin or placebo for an additional 5 days.
The study's primary end point was clinical success and pneumonia severity score at 10 days after the start of treatment. Based on these criteria, 50 of the 56 patients (89%) who received 3 days of active treatment were cured or significantly improved, compared with 56 of 63 (89%) patients in the group receiving 8 days of treatment, Dr. El Moussaoui reported at the conference, sponsored by the American Society for Microbiology.
The two groups also showed very similar rates of bacteriologic cure and radiologic cure. The study's secondary end point was clinical success at 28 days after the start of treatment. This goal was achieved by 84% of patients who had 3 days of treatment and by 78% of those who received 8 days of treatment. The median hospital length of stay was 6 days in the 3-day group and 7 days in the 8-day group. The incidence of adverse events was 11% in the 3-day group and 21% in the 8-day group.
If a strategy of 3 days of antibiotic treatment were applied to similar pneumonia patients in routine practice, it could lead to a major drop in antibiotic use and might help contain antibiotic resistance.
KEVIN FOLEY, RESEARCH/FORHAD S. HOSSAIN, DESIGN