An extended course of antibiotics did not offer any additional advantages over the standard course of antibiotics in terms of adverse effects, nasopharyngeal carriage and antibiotic resistance in a short-term analysis, according to a study reported in The Pediatric Infectious Diseases Journal.¹

In this multinational trial, researchers from Australia, New Zealand, Singapore and Malaysia assessed the effectiveness of an extended course of antibiotics (13-14 days) compared to a standard course for 5-6 days in children, aged 3 months to ≤5 years, who were hospitalized with uncomplicated CAP. The study participants were initially managed with IV antibiotics for 1-3 days followed by oral amoxicillin-clavulanate for 3 days. Out of a total of 324 children included, 163 were assigned to the extended antibiotic course, while 161 received antibiotics for the standard duration. Nasopharyngeal swabs were also collected at baseline and at 4 weeks.

At 4 weeks, clinical cure evident by complete resolution of respiratory signs or symptoms was achieved in nearly 78% children administered antibiotics for an extended duration, whereas in the standard duration group, 81.3% children were clinically cured. Requirement of oxygen supplementation was higher in the extended-course group. But there were no major differences with regard to adverse events between the two groups; 26% (extended course) vs ~20% (standard course). The bacteriological profile and antimicrobial resistance were also similar between the two groups at the time of study entry and at the study end.

The clinical cure rates in the two groups were comparable indicating that the extended course of antibiotics was not superior to the standard course of antibiotics in the short-term. The WHO recommends antibiotic treatment for 3-5 days in low- and middle-income countries; however, in high-income countries, the practice is to give antibiotics for 5-10 days. The authors have planned a follow-up study for two years to further study the beneficial impact of extended course of antibiotics in terms of chronic respiratory symptoms and/or signs.

Reference

1. McCallum GB, et al. Extended versus standard antibiotic course duration in children <5 years of age hospitalized with community-acquired pneumonia in high-risk settings: four-week outcomes of a multicenter, double-blind, parallel, superiority randomized controlled trial. Pediatr Infect Dis J. 2022 Apr 25. doi: 10.1097/INF.0000000000003558