Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-risk Settings: A Randomized Controlled Trial

Hing C. Kok; Gabrielle B. McCallum; Stephanie T. Yerkovich; Keith Grimwood; Siew M. Fong; Anna M. Nathan; Catherine A. Byrnes; Robert Ware; Nachal Nachiappan; Noorazlina Saari; Peter S Morris; Tsin W. Yeo; Victor Oguoma; I. Brent Masters; Jessie A. de Bruyne; Kah P. Eg; Bilawara Lee; Mong H. Ooi; John W. Upham; Paul J. Torzillo; Anne B Chang

doi:10.1097/INF.0000000000004407

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Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-risk Settings: A Randomized Controlled Trial

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Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-risk Settings: A Randomized Controlled Trial

Hing C. Kok, Gabrielle B. McCallum, Stephanie T. Yerkovich, Keith Grimwood, Siew M. Fong, Anna M. Nathan, Catherine A. Byrnes, Robert Ware, Nachal Nachiappan, Noorazlina Saari, …

The Pediatric Infectious Disease Journal, Vol.43(9), pp.872-879

2024

DOI: https://doi.org/10.1097/INF.0000000000004407

PMID: 38830139

Abstract

Background: Pediatric community-acquired pneumonia (CAP) can lead to long-term respiratory sequelae, including bronchiectasis. We determined if an extended (13–14 days) versus standard (5–6 days) antibiotic course improves long-term outcomes in children hospitalized with CAP from populations at high risk of chronic respiratory disease. Methods: We undertook a multicenter, double-blind, superiority, randomized controlled trial involving 7 Australian, New Zealand, and Malaysian hospitals. Children aged 3 months to ≤5 years hospitalized with radiographic-confirmed CAP who received 1–3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, were randomized to either extended-course (8-day oral amoxicillin-clavulanate) or standard-course (8-day oral placebo) arms. Children were reviewed at 12 and 24 months. The primary outcome was children with the composite endpoint of chronic respiratory symptoms/signs (chronic cough at 12 and 24 months; ≥1 subsequent hospitalized acute lower respiratory infection by 24 months; or persistent and/or new chest radiographic signs at 12-months) at 24-months postdischarge, analyzed by intention-to-treat, where children with incomplete follow-up were assumed to have chronic respiratory symptoms/signs (“worst-case” scenario). Results: A total of 324 children were randomized [extended-course (n = 163), standard-course (n = 161)]. For our primary outcome, chronic respiratory symptoms/signs occurred in 97/163 (60%) and 94/161 (58%) children in the extended-courses and standard-courses, respectively [relative risk (RR) = 1.02, 95% confidence interval (CI): 0.85–1.22]. Among children where all sub-composite outcomes were known, chronic respiratory symptoms/signs between groups, RR = 1.10, 95% CI: 0.69–1.76 [extended-course = 27/93 (29%) and standard-course = 24/91 (26%)]. Additional sensitivity analyses also revealed no between-group differences. Conclusion: Among children from high-risk populations hospitalized with CAP, 13–14 days of antibiotics (versus 5–6 days), did not improve long-term respiratory outcomes.

Details

Title: Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-risk Settings: A Randomized Controlled Trial
Authors: Hing C. Kok (Corresponding Author) - Charles Darwin University
Gabrielle B. McCallum - Charles Darwin University
Stephanie T. Yerkovich - Charles Darwin University
Keith Grimwood - Gold Coast Health
Siew M. Fong - Sabah Environmental Trust
Anna M. Nathan - University of Malaya
Catherine A. Byrnes - Charles Darwin University
Robert Ware - Griffith University
Nachal Nachiappan - Tengku Ampuan Rahimah Hospital
Noorazlina Saari - Queensland University of Technology
Peter S Morris - Charles Darwin University
Tsin W. Yeo - Charles Darwin University
Victor Oguoma - Charles Darwin University
I. Brent Masters - Queensland University of Technology
Jessie A. de Bruyne - University of Malaya
Kah P. Eg - University of Malaya
Bilawara Lee - Sabah Environmental Trust
Mong H. Ooi - Sarawak General Hospital
John W. Upham - Translational Research Institute
Paul J. Torzillo - Menzies School of Health Research
Anne B Chang - Charles Darwin University
Publication details: The Pediatric Infectious Disease Journal, Vol.43(9), pp.872-879
Publisher: Lippincott Williams & Wilkins
Date published: 2024
DOI: 10.1097/INF.0000000000004407
ISSN: 1532-0987
PMID: 38830139
Grants: Improving children’s lung health especially for First Nations children through feasible interventions, complemented by novel discovery science, 2025379, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Improving the lung health of children especially for Aboriginal and Torres Strait Islander children, 1154302, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Centre for Research Excellence in Lung Health of Aboriginal and Torres Strait Islander Children, 1040830, National Health and Medical Research Council (Australia, Canberra) - NHMRC
A multi-centre double-blind RCT on community-acquired pneumonia in Indigenous children and a developing country: Improving clinical outcomes and identifying systemic biomarkers, 1098443, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Grant note: The New Zealand site was supported by a 2-year grant from CureKids, New Zealand (grant 3571). The Kuala Lumpur site was partially funded by a University of Malaya Research Grant (RP026-14HTM). H.C.K. is supported by a Charles Darwin International PhD Scholars (CDIPS) Scholarship.
Organisation Unit: Thompson Institute
Language: English
Record Identifier: 991113151602621
Output Type: Journal article