The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children

Rebecca, G; Amoah, Joe; Hsu, Alice J.; Hersh, Adam L.; Sklansky, Daniel J.; Cosgrove, Sara E.

doi:10.1093/jpids/piaa055

Cited by 38 publications

(40 citation statements)

References 30 publications

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“…Inclusion to the analyses was limited to children with clinical and radiographic criteria consistent with pneumonia, which means that spontaneous recovery that is common in outpatient studies with milder CAP symptoms, was improbable. Four per cent of children experienced treatment failure with no significant differences between the two study groups 25 …”

Section: Duration Of Treatmentmentioning

confidence: 82%

“…Four per cent of children experienced treatment failure with no significant differences between the two study groups. 25 A prospective, blinded, parallel-group, non-inferiority RCT study comparing five days versus 10-day durations of antibiotic courses was carried out in two Canadian centres in 2016-2019 and published in 2021, 26 which was after the PubMed search of references for this mini-review. In all, 281 children aged from six months to 10 years (median 2.6 years, boys 57.7%) were treated as outpatients for CAP.…”

Section: Pneumonia Tre Ated In Hos Pitalmentioning

confidence: 99%

“…5 A retrospective one-centre cohort study from the United States included 168 children aged over 6 months, who were hospitalised for CAP and received short-course antibiotic therapy of 6 days (median), and 271 children who received long-course therapy of 10 or more days. 25 Inclusion to the analyses was limited to children with clinical and radiographic criteria consistent with pneumonia, which means that spontaneous recovery that is common in outpatient studies with milder CAP symptoms, was improbable. Four per cent of children experienced treatment failure with no significant differences between the two study groups.…”

Section: Pneumonia Tre Ated In Hos Pitalmentioning

confidence: 99%

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Antibiotic therapy in children with community‐acquired pneumonia

Korppi

2021

Acta Paediatrica

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British and American guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in children are 10 years old. The British Thoracic Society (BTS) updated the guidelines for the management of CAP in children in 2011, 1 and the Infectious Diseases Society of America (IDSA) and the Pediatric Infectious Diseases Society of America updated the guidelines for the management of CAP in infants and children older than 3 months likewise in 2011. 2 World Health Organization (WHO) revised the guidelines for classification and treatment of childhood pneumonia at health facilities in 2013. 3 The Finnish Current Care Guidelines for lower respiratory tract infections in children, including guidelines for paediatric CAP, were published in 2014 (available at www.kaypa hoito.fi).The aim of this mini-review was to update the available clinical data on antibiotic treatment of CAP in children aged more than 1 month. Pneumonia during the neonatal period, hospital-acquired pneumonia and pneumonia in children with an outstanding underlying illness or immunity-modifying treatment were out of scope of this review.

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Section: Duration Of Treatmentmentioning

confidence: 82%

Section: Pneumonia Tre Ated In Hos Pitalmentioning

confidence: 99%

Section: Pneumonia Tre Ated In Hos Pitalmentioning

confidence: 99%

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Antibiotic therapy in children with community‐acquired pneumonia

Korppi

2021

Acta Paediatrica

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“…No other studies explicitly examined duration of treatment and clinically relevant outcomes. While recent data investigating community‐acquired pneumonia suggest shorter duration of antimicrobial therapy may be effective, these studies do not include children with existing pulmonary disease 82,83 . In the absence of high‐quality, reliable evidence, clinicians extrapolate data from related but clinically distinct populations (i.e., endotracheally intubated patients) to guide therapy.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis, management, and outcomes of pediatric tracheostomy‐associated infections: A scoping review

Morrison

Hassan

Kysh

et al. 2022

Pediatric Pulmonology

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Background: Children with tracheostomy are frequently admitted to the hospital for tracheostomy-associated respiratory infections (TRAINs). However, there remains a paucity of evidence to direct the diagnosis, treatment, and prevention of TRAINs. An important first step to addressing this knowledge gap is to synthesize existing data regarding TRAINs to inform current practice and facilitate innovation. Data Sources: We searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science from inception to October 2020. Original research articles and published abstracts including children and young adults 0-21 years of age with tracheostomy were included. Included studies assessed the clinical definitions of and risk factors for TRAINs, microbiologic epidemiology and colonization of tracheostomies, and treatment and outcomes of TRAINs. Data Synthesis: Out of 5755 studies identified in the search, 78 full-text studies were included in the final review. A substantial number of studies focused on the detection of specific pathogens in respiratory cultures including Pseudomonas aeruginosa. Several different definitions of TRAIN including clinical, microbiologic, and laboratory testing results were utilized; however, no uniform set of criteria were identified. The few studies focused on treatment and prevention of TRAIN emphasized the role of empiric antimicrobial therapy and the use of inhaled antibiotics. Conclusions: Despite a growing number of research articles studying TRAINs, there is a paucity of prospective interventional trials to guide the diagnosis, treatment, and prevention of respiratory disease in this vulnerable population. Future research should include studies of interventions designed to improve short-and long-term respiratory-related outcomes of children with tracheostomy.

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“…These include an observational study and 4 RCTs. [12][13][14][15]29 There are, however, important methodologic differences between these studies and our own. Only 2 studies included children hospitalized with pneumonia, one from the United States 29 and another from the United Kingdom and Ireland, the Community-Acquired Pneumonia: a randomized controlled trial (CAP-IT) trial.…”

Section: Discussionmentioning

confidence: 99%

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

McCallum

Fong²,

Grimwood

et al. 2022

Pediatric Infectious Disease Journal

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Background: High-level evidence is limited for antibiotic duration in children hospitalized with community-acquired pneumonia (CAP) from First Nations and other at-risk populations of chronic respiratory disorders. As part of a larger study, we determined whether an extended antibiotic course is superior to a standard course for achieving clinical cure at 4 weeks in children 3 months to ≤5 years old hospitalized with CAP. Methods: In our multinational (Australia, New Zealand, Malaysia), double-blind, superiority randomized controlled trial, children hospitalized with uncomplicated, radiographic-confirmed, CAP received 1–3 days of intravenous antibiotics followed by 3 days of oral amoxicillin-clavulanate (80 mg/kg, amoxicillin component, divided twice daily) and then randomized to extended (13–14 days duration) or standard (5–6 days) antibiotics. The primary outcome was clinical cure (complete resolution of respiratory symptoms/signs) 4 weeks postenrollment. Secondary outcomes included adverse events, nasopharyngeal bacterial pathogens and antimicrobial resistance at 4 weeks. Results: Of 372 children enrolled, 324 fulfilled the inclusion criteria and were randomized. Using intention-to-treat analysis, between-group clinical cure rates were similar (extended course: n = 127/163, 77.9%; standard course: n = 131/161, 81.3%; relative risk = 0.96, 95% confidence interval = 0.86–1.07). There were no significant between-group differences for adverse events (extended course: n = 43/163, 26.4%; standard course, n = 32/161, 19.9%) or nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus or antimicrobial resistance. Conclusions: Among children hospitalized with pneumonia and at-risk of chronic respiratory illnesses, an extended antibiotic course was not superior to a standard course at achieving clinical cure at 4 weeks. Additional research will identify if an extended course provides longer-term benefits.

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The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children

Cited by 38 publications

References 30 publications

Antibiotic therapy in children with community‐acquired pneumonia

Antibiotic therapy in children with community‐acquired pneumonia

Diagnosis, management, and outcomes of pediatric tracheostomy‐associated infections: A scoping review

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

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