Antibiotics treatment duration for community-acquired pneumonia

At the 2024 American Academy of Pediatrics (AAP) National Conference & Exhibition, Rana Hamdy, MD, a pediatric infectious diseases physician at Children’s National Hospital in Washington, D.C., provided valuable updates on the management of community-acquired pneumonia (CAP) in children. A key part of her discussion focused on optimizing antibiotic therapy, particularly the duration of treatment.

"We probably don't have that much different in terms of choice of antibiotic. High-dose amoxicillin remains the best antibiotic as it continues to cover the vast majority of Streptococcus pneumonia, which is the major bacteria that causes bacterial pneumonia," said Hamdy.

However, she emphasized that the most significant change in recent years relates to the duration of therapy. Hamdy noted that every additional day of antibiotics increases the risk of adverse drug-related events, such as rash, diarrhea, disruptions to the microbiome, and Clostridium difficile (C. diff) infections, along with increased antibiotic resistance.

“Shortening that, your default antibiotic course, from 10 days to 5 days really does make an impact,” she explained.

In addition to antibiotic duration, Hamdy urged pediatricians to critically assess documented allergies in patients, particularly those labeled with penicillin allergies. "10% of children actually have a documented penicillin allergy, but less than 1% have a true allergy," she noted. Mislabeling of penicillin allergies can lead to the use of broader-spectrum antibiotics, which are often less effective and come with a higher risk of adverse effects.

"It's important to question that, to take really good allergy histories," Hamdy emphasized, noting that treating patients with second-line antibiotics based on incorrect assumptions about allergies can result in inferior therapy and increased risks.

Hamdy’s key takeaway for pediatricians is to rethink the standard practices around antibiotic use. She highlighted the need for shorter courses of antibiotics whenever possible and encouraged clinicians to challenge assumptions about amoxicillin allergies.

"If a patient has a labeled allergy, really think about that critically. Do they really have an allergy? Take a very good allergy history and question if that really is a true allergy" she advised.