Impact of reducing the duration of antibiotic treatment on the long-term
prognosis of community acquired pneumonia.
Rationale: The optimal duration of antibiotic treatment for
community-acquired pneumonia (CAP) is not well established. The aim of
this study was to assess the impact of reducing the duration of
antibiotic treatment on long-term prognosis in patients hospitalized
with CAP. Methods: This was a multicenter study assessing complications
developed during one year of patients previously hospitalized with CAP
who had been included in a randomized clinical trial concerning the
duration of antibiotic treatment. Mortality at 90 days, at 180 days and
at 1 year were analyzed, as well as new admissions and cardiovascular
complications. A subanalysis was carried out in one of the hospitals by
measuring C-reactive protein (CRP), procalcitonin (PCT) and
proadrenomedullin (proADM) at admission, at day 5 and at day 30.
Results: A total of 312 patients were included, 150 in the control group
and 162 in the intervention group. 90 day, 180 day and 1-year mortality
in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14
(4.50%), respectively. There were no significant differences between
both groups in terms of 1-year mortality (p=0.94), new admissions (p=
0.84) or cardiovascular events (p=0.33). No differences were observed
between biomarker level differences from day 5 to day 30 (CRP p=0.29;
PCT p=0.44; proADM p=0.52). Conclusions: Reducing antibiotic treatment
in hospitalized patients with CAP based on clinical stability criteria
is safe, without leading to a greater number of long-term complications.