Reviewed by Hannah Imlay, MD, MS, University of Utah Health
In this non-inferiority randomized controlled trial across 16 centers in France, adults admitted with community-acquired pneumonia (CAP) who were clinically stable after 3 days of beta-lactam therapy had similar outcomes if they got placebo vs amoxicillin-clavulanic acid for the remaining 5 days. In the intention-to-treat analysis, day 15 cure occurred in 77% (117/152) of the placebo arm versus 68% (102/151) of beta-lactam arm; in the per protocol analysis, cure occurred in 78% of the placebo arm vs 68% of the beta-lactam arm, meeting the non-inferiority criteria. Adverse events were similar between groups. Important exclusions included severe CAP (defined as those requiring ICU care), immunocompromised patients, and those with healthcare-associated pneumonia. Among patients who had sputum cultures done, only 12% of samples grew a causative pathogen, suggesting that some enrolled patients did not have a bacterial etiology for their CAP. However, these data suggest that among non-immunocompromised, non-severely ill patients that are clinically improved at day 3, three days of antibiotics are likely sufficient for CAP.
Reference:
Dinh A, Ropers J, Duran C, et al.; Pneumonia Short Treatment (PTC) Study Group. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet. 2021 Mar 27;397(10280):1195-1203. doi: 10.1016/S0140-6736(21)00313-5. PMID: 33773631.