Short duration of antibiotic therapy in hospitalized patients with community-acquired pneumonia: results from the CAPO International Cohort Study

Abstract

Background: Experts suggest a short duration of antibiotic therapy (DOT) in responding patients with community-acquired pneumonia (CAP). The aim of this study was to evaluate clinical outcomes after hospital discharge among patients treated with short-course antibiotic therapy (SCT) vs. long-course antibiotic therapy (LCT) for CAP. Methods: A secondary analysis of the Community-Acquired Pneumonia Organization (CAPO) database from January 2007 to June 2013 was performed, including hospitalized CAP patients who reached clinical stability within 5 days. Two groups were identified: patients who were treated with antibiotic therapy for a total duration of 5 days or less (SCT Group) vs. longer than 5 days (LCT Group). Rehospitalization and mortality were evaluated at 30 days after discharge. Results: 1,849 patients were enrolled (58% males; median age: 65 years), 179 (10%) were included in the SCT and 1,670 (90%) in the LTC group. Median DOT was 5 days in the SCT and10 days in the LTC group, p<0.001. At 30-day follow-up, there were no deaths in the SCT group, while 8 patients (0.7%) died in the LCT group, p=0.488. A total of 13 (11%) rehospitalizations were detected at 30 days after discharge in the SCT group vs. 132 (11%) in the LCT group, p=0.879. Once adjusted for several confounders, a short duration of antibiotic therapy was not associated to either adverse outcomes (OR: 1.04; 95% CI: 0.54-1.99; p=0.912). Conclusions: A duration of antibiotic therapy of ≤ 5 days does not adversely impact clinical outcomes at 30-days after discharge compared to > 5 days in patients who reached early clinical stability.