Recently there have been a number of studies examining the role of antibiotics in community acquired pneumonia (CAP). In recent months Archivist has highlighted two of them. There is clear evidence that lower dose, shorter courses are non-i nferior to higher dose with longer courses. The drive behind these studies is the concern about antimicrobial resistance (AMR). Is there any evidence that the shorter course has an effect on AMR? Williams DJ et al (JAMA Pediatr. Published online January 18, 2022. doi:10.1001/jamapediatrics.2021.5547) have looked at this as part of their SCOUT-CAP randomised clinical trial. They have conducted a randomised clinical trial of previously well children with community-acquired pneumonia where a 5 day antibiotic strategy resulted in similar treatment response with fewer antibiotic days compared with a 10-day strategy. Most importantly, the 5 day strategy was associated with a significantly lower abundance of antibiotic resistance genes. So, the overall conclusion was that among young children responding to initial therapy, a 5 day antibiotic strategy was superior to a 10-day strategy for treatment of nonsevere pneumonia, on the basis of the favourable AMR differences.
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