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Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7554.1355 (Published 08 June 2006) Cite this as: BMJ 2006;332:1355

Shorter duration of antibiotics - not yet hurray

A shorter duration of antibiotics for the treatment of community
acquired pneumonia would be very welcome by most clinicians if this is
backed by robust evidence and its findings can be translated to real
clinical practice.

The study by Moussaoui et al [1], supported by the follow-up
commentary by John Paul[2], seem to suggest that 3-day course of
antibiotics- in this case amoxycillin- is not inferior to the traditional
7-10 course favoured by respected guidelines like that of the British
Thoracic Society and therefore should be revised [2].

For instance, an impression was given by both the study and follow-up
commentary that a 3-day course of intravenous (emphasis mine)antibiotics
administered to participants 'as the preferred empirical treatment in the
Netherlands'for uncomplicated community acquired pneumonia is equivalent
to a 3-day course of oral antibiotic. Besides, being very misleading, the
dosage of the I.V.antibiotics was not stated. It was more convenient to
state the oral dose (750mg tds) and even this would be out of place in
clinical practice in the UK for uncomplicated pneumonia.

The majority of community acquired pneumonia participants in this
study described as 'mild to moderate' would be managed in general practice
in the UK (instead of secondary/tertiary setting) and the favoured, cost-
effective and efficacious route for antibiotics would be oral.
Furthermore, the arguement put forward by the authors that a shorter
course of antibiotics is more likely to contain the growing resistance
rates among respiratory pathogens goes against current scientific
discourse including multidrug resistance in tuberculosis.

This is an example of why we should be very cautious in translating
research findings into everyday clinical practice. Yes, we do need robust
evidence to back or refute present recommended antimicrobial duration for
community acquired pneumonia. The over-riding determinant should not just
be proof of cost-cutting but the interest of our patients.

References

1.Moussaoui et al. Effectiveness of discontinuing antibiotic
treatment after 3 days versus 8 days in mild to moderate-severe community
acquired pneumonia: randomised, double blind study.BMJ 2006;332:1355-58.

2. Paul J. Commentary: What is the optimal duration of antibiotic
therapy? BMJ 2006;332:1358.

Competing interests:
None declared

Competing interests: No competing interests

13 June 2006
Nosa Akporehwe
Locum Consultant
Kerstin A. Akporehwe, General Practitioner, Mountbatten Medical Centre, Hebburn
Hunters Moor Regional Neurological Rehabilitation Centre, Newcastle upon Tyne NE2 4NR