Ultrashort antibiotics course as effective as longer regimen for pneumonia with normal oxygenation: Study

USA: According to a new study appearing in The Journal of Clinical Infectious diseases,  an "ultrashort" course of antibiotics Is as  effective as a longer course in individuals with normal oxygen saturation levels who are treated for potential pneumonia.

Community-acquired pneumonia is a frequent and dangerous condition with high rates of morbidity and mortality. According to the severity of the illness, different antibiotic regimens are advised for patients who are in intensive care units, who are in-patients, and who are outpatients. Antibiotics are typically prescribed to hospitalized patients for suspected pneumonia, although this diagnosis is frequently made too soon, added the researchers.

According to the study's principal author, Michael Klompas, "We regularly found hospitalized patients whose primary care teams had started them on medicines for probable pneumonia, however on evaluation of their vital signs, their oxygenation levels were normal."

The authors of the study investigated whether normal oxygenation may be used as a sign to encourage early antibiotic withdrawal.

According to their findings, 25% of pneumonia patients receiving hospital treatment had oxygen saturation levels above 95% in ambient air. Also, the results were the same whether antibiotics were taken for 1-2 or 5-8 days.

For this objective, in 4 hospitals, between May 2017 and February 2021, they retrospectively evaluated 39,752 participants who had been prescribed antibiotics for pneumonia and had oxygen saturations of more than 95% on ambient air. Utilizing sub-distribution hazard ratios, they evaluated in-patient mortality and time to discharge among 2871 patients treated for 1-2 days vs. 2891 patients treated for 5-8 days and 4478 patients who underwent propensity matching. Readmission rates, 30-day mortality, Clostridium difficile infections, days spent outside of the hospital, and days spent without antibiotics were all considered secondary endpoints.

Key findings of the study:

 Without supplemental oxygen, 10,012 people had median oxygen saturation levels of more than 95%.

 The hospital mortality rate for patients treated for 1-2 days compared to those treated for 5-8 days was comparable (2.1% vs. 2.8%); however, the time to discharge was shorter (6.1 vs. 6.6 days); and the number of 30-day hospital-free days was higher (23.1 vs. 22.7).

 No significant changes in 30-day readmissions (16.0% vs 15.8%), 30-day mortality (4.6% vs 5.1%) or 90-day C. difficile infections (1.3% vs 0.8%)were seen.

Researchers arrived at the conclusion that identifying candidates for early antibiotic withdrawal may be aided by normal oxygenation levels. They also stated that further prospective studies are necessary.

REFERENCE:

Klompas M, McKenna C, Ochoa A, Ji W, Chen T, Young J, Rhee C; CDC Prevention Epicenters. Ultrashort course antibiotics for suspected pneumonia with preserved oxygenation. Clin Infect Dis. 2022 Jul 27:ciac616. doi: 10.1093/cid/ciac616. Epub ahead of print. PMID: 35883250.