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Individualizing duration of antibiotic therapy in community-acquired pneumonia

Individualizing duration of antibiotic therapy in community-acquired pneumonia
Individualizing duration of antibiotic therapy in community-acquired pneumonia

International experts suggest tailoring antibiotic duration in community-acquired pneumonia (CAP) according to patients' characteristics. We aimed to assess the effectiveness of an individualized approach to antibiotic duration based on time in which CAP patients reach clinical stability during hospitalization. In a multicenter, non-inferiority, randomized, controlled trial hospitalized adult patients with CAP reaching clinical stability within 5 days after hospitalization were randomized to a standard vs. individualized antibiotic duration. In the Individualized group, antibiotics were discontinued 48 h after the patient reached clinical stability, with at least five days of total antibiotic treatment. Early failure within 30 days was the primary composite outcome. 135 patients were randomized to the Standard group and 125 to the Individualized group. The trial was interrupted by the safety committee because of an apparent inferiority of the Individualized group over the Standard treatment: 14 (11.2%) patients in the Individualized group experienced early failure vs. 10 (7.4%) patients in the Standard group, p = 0.200, at the intention-to-treat analysis. 30-day mortality rate was four-time higher in the Individualized group than the Standard group. Shortening antibiotic duration according to patients' characteristics still remains an open question.

1094-5539
191-201
Aliberti, Stefano
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Ramirez, Julio
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Giuliani, Fabio
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Wiemken, Timothy
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Sotgiu, Giovanni
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Tedeschi, Sara
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Carugati, Manuela
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Valenti, Vincenzo
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Marchioni, Marco
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Camera, Marco
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Piro, Roberto
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Del Forno, Manuela
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Milani, Giuseppe
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Faverio, Paola
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Richeldi, Luca
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Deotto, Martina
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Villani, Massimiliano
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Voza, Antonio
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Tobaldini, Eleonora
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Bernardi, Mauro
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Bellone, Andrea
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Bassetti, Matteo
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Blasi, Francesco
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Aliberti, Stefano
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Ramirez, Julio
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Giuliani, Fabio
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Wiemken, Timothy
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Sotgiu, Giovanni
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Tedeschi, Sara
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Carugati, Manuela
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Valenti, Vincenzo
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Marchioni, Marco
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Camera, Marco
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Piro, Roberto
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Del Forno, Manuela
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Milani, Giuseppe
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Faverio, Paola
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Richeldi, Luca
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Deotto, Martina
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Villani, Massimiliano
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Voza, Antonio
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Tobaldini, Eleonora
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Bernardi, Mauro
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Bellone, Andrea
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Bassetti, Matteo
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Blasi, Francesco
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Aliberti, Stefano, Ramirez, Julio, Giuliani, Fabio, Wiemken, Timothy, Sotgiu, Giovanni, Tedeschi, Sara, Carugati, Manuela, Valenti, Vincenzo, Marchioni, Marco, Camera, Marco, Piro, Roberto, Del Forno, Manuela, Milani, Giuseppe, Faverio, Paola, Richeldi, Luca, Deotto, Martina, Villani, Massimiliano, Voza, Antonio, Tobaldini, Eleonora, Bernardi, Mauro, Bellone, Andrea, Bassetti, Matteo and Blasi, Francesco (2017) Individualizing duration of antibiotic therapy in community-acquired pneumonia. Pulmonary Pharmacology and Therapeutics, 45, 191-201. (doi:10.1016/j.pupt.2017.06.008).

Record type: Article

Abstract

International experts suggest tailoring antibiotic duration in community-acquired pneumonia (CAP) according to patients' characteristics. We aimed to assess the effectiveness of an individualized approach to antibiotic duration based on time in which CAP patients reach clinical stability during hospitalization. In a multicenter, non-inferiority, randomized, controlled trial hospitalized adult patients with CAP reaching clinical stability within 5 days after hospitalization were randomized to a standard vs. individualized antibiotic duration. In the Individualized group, antibiotics were discontinued 48 h after the patient reached clinical stability, with at least five days of total antibiotic treatment. Early failure within 30 days was the primary composite outcome. 135 patients were randomized to the Standard group and 125 to the Individualized group. The trial was interrupted by the safety committee because of an apparent inferiority of the Individualized group over the Standard treatment: 14 (11.2%) patients in the Individualized group experienced early failure vs. 10 (7.4%) patients in the Standard group, p = 0.200, at the intention-to-treat analysis. 30-day mortality rate was four-time higher in the Individualized group than the Standard group. Shortening antibiotic duration according to patients' characteristics still remains an open question.

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More information

Accepted/In Press date: 26 June 2017
e-pub ahead of print date: 27 June 2017

Identifiers

Local EPrints ID: 443484
URI: http://eprints.soton.ac.uk/id/eprint/443484
ISSN: 1094-5539
PURE UUID: 16656a0a-a1f8-4efe-847e-1c0e6012ff56

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Date deposited: 26 Aug 2020 16:36
Last modified: 07 Oct 2020 00:39

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Contributors

Author: Stefano Aliberti
Author: Julio Ramirez
Author: Fabio Giuliani
Author: Timothy Wiemken
Author: Giovanni Sotgiu
Author: Sara Tedeschi
Author: Manuela Carugati
Author: Vincenzo Valenti
Author: Marco Marchioni
Author: Marco Camera
Author: Roberto Piro
Author: Manuela Del Forno
Author: Giuseppe Milani
Author: Paola Faverio
Author: Luca Richeldi
Author: Martina Deotto
Author: Massimiliano Villani
Author: Antonio Voza
Author: Eleonora Tobaldini
Author: Mauro Bernardi
Author: Andrea Bellone
Author: Matteo Bassetti
Author: Francesco Blasi

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