Comparable outcomes with 5 days and 10 days of antibiotics in children with community-acquired pneumonia (SCOUT-CAP)

Reference

Williams DJ, Creech CB, Walter EB, et al, for the The DMID 14-0079 Study Team. Short- vs standard-course outpatient antibiotic therapy for community-acquired pneumonia in children: the SCOUT-CAP randomized clinical trial. JAMA Pediatr 2022;176(3):253-261.

Synopsis

This study took place in multiple settings: outpatient clinics, urgent care centers, and emergency departments. The researchers enrolled children 6 months to 71 months of age with clinically diagnosed uncomplicated community-acquired pneumonia (CAP). When enrolled, the children had already been treated with 3 to 5 days of amoxicillin, amoxicillin plus clavulanate, or cefdinir, independent of study protocol. At the time of enrollment, the children were doing well (ie, afebrile, not tachypneic, and no severe cough). After completion of 5 days of the initial therapy, these children were then randomized to receive either 5 days of placebo (n = 189) or an additional 5 days of the original antibiotic (n = 191). The researchers evaluated the children serially until 25 days after enrollment using a composite scale (based on clinical response, resolution of symptoms, and adverse effects) that they adjusted for duration of antibiotics. There were no significant differences in any of the individual components of the composite. However, the authors report that when adjusted for duration, 5 days of antibiotics was associated with a greater probability of a desirable outcome (0.69, 95% CI 0.63 - 0.75) than 10 days of therapy. A subset of 171 children agreed to have throat swabs 19 to 25 days after enrollment to test for antibiotic resistance genes; the number of these were significantly lower in the children treated for 5 days. Curiously, the authors did not report actual bacterial resistance.