Spectrum: Local Antimicrobial Stewardship, for Eastern Health

Community Acquired Pneumonia Duration of Therapy

Recommended Duration

5 days

CAP Management

Shortest Duration

Minimum duration studied without evidence of reduced efficacy

3 days

Switch to PO

Consider transition to PO antimicrobial on Day 2 of therapy, if patient is improving clinically, can absorb oral intake, and there is an appropriate oral drug for identified organism(s)

Drugs with High Oral Bioavailability

Excluded Patients

  • Immunosuppressed patients

  • Patients with underlying lung disease (e.g. CF)

  • Patients requiring mechanical ventilation

Additional Notes

  • The evidence for short course therapy for pneumonia is strong

  • Original data from the 1940s confirmed safety of shorter durations of therapy, and more recent clinical trials and meta- analysis have confirmed efficacy, even in severe disease and bacteraemia

  • Five day duration in guidelines has been confirmed by meta-analysis and confirmatory clinical trials

  • Shorter courses of 3 days also have randomized, blinded controlled trial data, but these are less well accepted

  • In children, shorter courses are becoming the standard of care

  • Adapted from AMMI Canada Position Statement on the Appropriate Duration of Antimicrobial Therapy (2018)

More Information

References
  1. El Moussaoui R, de bourgie van den broek et al., Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ, 2006; 332:13555
  2. MASCOT study group, Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet. 360(9336):835-41. 2002
  3. Dimopoulos G, Matthaiou D, Karagergopoulos D et al. Short- versus Long-Course Antibacterial Therapy for Community-Acquired Pneumonia A Meta-Analysis. Drugs, 68 (13): 1841-1854. 2008
  4. Ghazipura M, Shorter Versus Longer Duration of Antibiotic Therapy in Patients With Community- Acquired Pneumonia: A Rapid Review. Toronto, ON: Health Quality Ontario; 2013 November. 20 Available Here
  5. Uranga A, Espana P, Bilboa A et al., Duration of Antibiotic Treatment in Community-Acquired Pneumonia A Multicenter Randomized Clinical Trial. JAMA Intern Med. 2016;176(9):1257-1265