From the Guidelines
The recommended treatment course length for antibiotic treatment of pneumococcal pneumonia in an inpatient setting is at least 5 days.
Key Points
- The American Thoracic Society and Infectious Diseases Society of America recommend a minimum of 5 days of antibiotics for community-acquired pneumonia (CAP) in the inpatient setting, with extension of therapy guided by validated measures of clinical stability 1.
- A meta-analysis of 21 studies found that short courses (≤ 6 days) of antibiotic therapy were as effective as long courses, with fewer serious adverse events and lower mortality 1.
- The American College of Physicians recommends prescribing antibiotics for CAP for a minimum of 5 days, with extension of therapy guided by clinical stability 1.
- A recent meta-analysis of 19 randomized controlled trials found no difference in clinical cure rates between short course treatment (≤6 days) and treatment for ≥7 days, regardless of patient setting or severity of pneumonia 1.
- The IDSA/ATS 2019 guideline recommends continuing antibiotics until the patient achieves stability, using a validated measure of clinical stability, and for a duration of not less than 5 days 1.
Treatment Considerations
- The choice of antibiotic should cover common pathogens, such as S pneumoniae, H influenzae, Mycoplasma pneumoniae, and Staphylococcus aureus 1.
- Serial measurements of biomarkers, such as procalcitonin, can help with antibiotic de-escalation without increasing mortality or treatment failure 1.
- For patients with bacteremic pneumococcal disease, antimicrobial therapy should be used for at least 10-14 days, and it is essential to ensure that there are no metastatic complications before discontinuation 1.
From the Research
Treatment Course Length for Pneumococcal Pneumonia
The recommended treatment course length for antibiotic treatment of pneumococcal (Streptococcus pneumoniae) pneumonia in an inpatient setting is a topic of ongoing research and debate.
- Several studies have investigated the optimal duration of antimicrobial treatment in adults with community-acquired pneumonia (CAP) 2, 3, 4, 5, 6.
- Current evidence suggests that shorter antibiotic courses (3-7 days) are non-inferior to longer courses (10 days) in terms of safety and efficacy, particularly in patients with mild to moderate CAP 2, 3, 5, 6.
- A systematic review and meta-analysis found that shorter treatment durations (3-5 days) may offer the optimal balance between efficacy and treatment burden for treating CAP in adults, if they achieve clinical stability 6.
- However, the optimal duration of antimicrobial treatment in hospital-acquired pneumonia (HAP) patients is still unclear and should be individually tailored to each patient, taking into account the causative pathogen and clinical response 2.
- Clinical criteria, such as stability criteria, and biomarkers, such as procalcitonin, may be useful in determining the optimal duration of antibiotic treatment in patients with pneumonia 3, 4.