Twenty-four Month Outcomes of Extended- Versus Standard Course Antibiotic Therapy in Children Hospitalized with Pneumonia in High-Risk Settings: A Randomized Controlled Trial

Read article: Submitted by: Rumeysa Yalcinkaya, MD . Department of Pediatric Infectious Diseases, Ankara Etlik City Hospital, Ankara/Turkiye.Background:Community-acquired pneumonia (CAP) in children from high-risk populations is associated with long-term respiratory complications. This study aimed to assess whether extended antibiotic therapy (13–14 days) offers better long-term respiratory outcomes compared to standard therapy (5–6 days) in hospitalized children.Findings:The study enrolled 324 children aged 3-months to 5-years who were hospitalized with radiographically confirmed pneumonia. Children with co-morbidities, complicated pneumonia, severe malnutrition, penicillin hypersensitivity, and those with other infections requiring additional antibiotic therapy were excluded. Participants were randomized into two groups. Both groups received intravenous antibiotics (amoxicillin-clavulanate) for 1–3 days, followed by 3 days of oral amoxicillin-clavulanate (400/57mg suspension at 80 mg/kg/day). The extended-course group received an additional 8 days of oral amoxicillin-clavulanate, while the standard-course group received an 8-day placebo. The primary outcome was the presence of chronic respiratory symptoms or signs (chronic cough, persistent and/or new chest X-ray abnormalities, or ≥1 subsequent hospitalization due to acute lower respiratory infections) at 24-months post discharge. The study found no significant difference between the extended- and standard-course groups in terms of the primary outcome (relative risk [RR] = 1.02, 95% confidence interval [CI]: 0.85–1.22). Sensitivity analyses and secondary outcomes, including time to next respiratory-related hospitalization, also showed no significant differences between groups.Take-home message: In children from high-risk populations hospitalized with CAP, extended antibiotic therapy does not provide long-term respiratory benefits compared to standard therapy. The standard 5–6-day course remains sufficient for managing uncomplicated pneumonia in these settings.

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Quiz Questions

1.
1. What was the primary outcome measured in this study?
- A.
  A) Resolution of symptoms at 4 weeks
- B.
  B) Development of antibiotic resistance
- C.
  C) Chronic respiratory symptoms/signs at 24 months
- D.
  D) Hospital readmission rates within 1 month
- E.
  E) Improvement in lung function at 12 months
2.
2. What was the conclusion regarding the extended antibiotic course in high-risk children with pneumonia?
- A.
  A) Reduction in chronic respiratory symptoms
- B.
  B) Increase in antibiotic-related side effects
- C.
  C) Reduction in hospital readmission rates
- D.
  D) No significant benefit over the standard course
- E.
  E) Improvement in lung function outcomes
3.
3. Which one is mentioned as a limitation in the study?
- A.
  A) Difficulty in reliably differentiating bacterial from nonbacterial pneumonia using biomarkers and CXRs.
- B.
  B) A lower number of participants completing both the 12- and 24-month reviews, partially due to COVID-19 lockdowns.
- C.
  C) Inability to perform lung function tests due to the young age of participants and study settings.
- D.
  D) The findings may not be applicable to children with underlying chronic conditions, high-risk groups and cases of complicated pneumonia.
- E.
  E) All of the above

Quiz Outcomes

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Results