Journal Information
Vol. 56. Issue 12.
Pages 835-836 (December 2020)
Vol. 56. Issue 12.
Pages 835-836 (December 2020)
Letter to the Editor
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Short-course antibiotic regimens in community-acquired pneumonia in children
Pautas cortas de antibioterapia en neumonías adquiridas en la comunidad en niños
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Lucía Sanjuán-Benitaa, Jesús Saavedra-Lozanoa,b,c, David Aguilera-Alonsoa,b,
Corresponding author
david.aguilera@salud.madrid.org

Corresponding author.
a Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
c Universidad Complutense de Madrid, Madrid, Spain
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To the Editor:

We have read with interest the recently published consensus document on community-acquired pneumonia (CAP) in children.1 We thank the authors for their efforts in producing recommendations for a disease that is highly prevalent in the pediatric age and has a very significant impact on the use of antibiotics. However, with regard to the duration of antibiotic treatment, we believe that, given current scientific evidence, a reduction in the length of antibiotic regimens in uncomplicated pneumonias could be considered.

The use of shorter antimicrobial therapies not only reduces costs and improves therapeutic adherence, but also reduces the risk of acquiring bacteria with antibiotic resistance, a problem of increasing concern today.

Several studies in the adult population have demonstrated similar effectiveness with short- and long-term antibiotic regimens in CAP. For example, the clinical trial of Uranga et al.2 found that an antibiotic regimen in which the antibiotic was discontinued 48 h after achieving clinical stability, with a minimum duration of 5 days, was not inferior to a full 10-day course.

Several studies have been published in the pediatric population on the treatment of CAP in patients aged 6 months and older with short antibiotic regimens. Same et al.3 retrospectively compared the rate of therapeutic failure in uncomplicated CAP in patients who had received a short antibiotic regimen of 5–7 days (median of 6 days) versus a long regimen of 8–14 days, and found no differences in treatment failure 30 days after the start of therapy.

Along these same lines, Greenberg et al.4 conducted a clinical trial in patients with CAP of probable bacterial etiology between 6 months and 5 years of age, in which they demonstrated the non-inferiority of a 5-day regimen of oral amoxicillin versus a 10-day regimen in terms of 30-day treatment failure rate. However, a 3-day regimen of antibiotic therapy increased the risk of treatment failure.

Patient recruitment in the SCOUT-CAP clinical trial (ClinicalTrials.gov: NCT02891915)5 on short antibiotic regimens in CAP in children has recently been completed. This is a multicenter, randomized, phase IV trial conducted in the US that has included patients 6–71 months of age, with the aim of comparing the efficacy of beta-lactams in a 5-day or 10-day regimen, to help determine the best duration of antibiotic therapy in these patients.

This growing scientific evidence has prompted recent updates of various clinical practice guidelines in both adults and children to suggest antibiotic regimens with a duration of less than 7 days in the treatment of CAP. These include, in particular, the British NICE guidelines,6 which recommend a 5-day regimen with amoxicillin, both in adults and in the pediatric population. Therefore, we believe that a recommendation of treatment regimens of less than 7 days in uncomplicated CAP may be more in line with current evidence.

Funding

This article has been partially funded by the Health Research Fund, Instituto de Salud Carlos III (ISCIII), co-funded by the European Regional Development Fund (ERDF), via the Contrato Rio Hortega DAA (CM18/00100).

References
[1]
A. Andrés-Martín, A. Escribano Montaner, J. Figuerola Mulet, M.L. García García, J.K. Muruae, D. Moreno-Pérez, et al.
Documento de consenso sobre la neumonía adquirida en la comunidad en los niños. SENP-SEPAR-SEIP.
[2]
A. Uranga, P.P. España, A. Bilbao, J.M. Quintana, I. Arriaga, M. Intxausti, et al.
Duration of antibiotic treatment in community-acquired pneumonia. A multicenter randomized clinical trial.
JAMA Intern Med., 176 (2016), pp. 1257-1265
[3]
R.G. Same, J. Amoah, A.J. Hsu, A.L. Hersh, D.J. Sklansky, S.E. Cosgrove, et al.
The association of antibiotic duration with successful treatment of community-acquired pneumonia in children.
J Pediatric Infect Dis Soc, (2020),
[4]
D. Greenberg, N. Givon-Lavi, Y. Sadaka, S. Ben-Shimol, J. Bar-Ziv, R. Dagan.
Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children. A double-blind, randomized, placebo-controlled trial.
Pediatr Infect Dis J, 33 (2014), pp. 136-142
[5]
ClinicalTrials.gov. National Library of Medicine (US). Trial to Evaluate Beta-Lactam Antimicrobial Therapy of Community Acquired Pneumonia in Children, https://clinicaltrials.gov/ct2/show/NCT02891915; 2019 [consultada el 7 de julio de 2020].
[6]
National Institute for Health and Care Excellence. Public Health England. Pneumonia (community-acquired): antimicrobial prescribing. NICE guideline [NG138], https://www.nice.org.uk/guidance/ng138/resources/pneumonia-communityacquired-antimicrobial-prescribing-pdf-66141726069445; 2019 [consultada el 7 de julio de 2020].

Please cite this article as: Sanjuán-Benita L, Saavedra-Lozano J, Aguilera-Alonso D. Pautas cortas de antibioterapia en neumonías adquiridas en la comunidad en niños. Arch Bronconeumol. 2020. https://doi.org/10.1016/j.arbres.2020.08.017

Copyright © 2020. SEPAR
Archivos de Bronconeumología

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