Introduction

The pneumonia short treatment (PTC) trial was a randomized placebo-controlled trial that studied antibiotic treatment duration among patients hospitalized with community-acquired pneumonia (CAP) in non-intensive care unit (ICU) wards. It demonstrated noninferiority between 3 and 8 days of treatment duration with betalactams.

Aim

To explore the effectiveness of exclusive oral antibiotic treatment for patients hospitalized for CAP.

Patient Profile

• N=200
• Study Centers: Non-ICU wards of 16 university hospitals in France
• Patients ≥18 years, hospitalized for CAP, treated with beta-lactams (left to the physician's choice), who demonstrated clinical response after 72 hours of treatment, defined by the presence of stability criteria according to the Infectious Diseases Society of America

Methods

• Exploratory post-hoc analysis of a randomized controlled double-blind trial (the PTC trial)

   

  Treatment

• Initial phase: Patients were treated exclusively with either IV or oral antibiotics for the first 3 days, using either a 3rd-generation cephalosporin (3GC, ceftriaxone or cefotaxime) or amoxicillin-clavulanate (AMC) regimen
• After Initial Phase: Patients were randomized to receive either 5 days of oral placebo or oral AMC for the remainder of the treatment

Fig 1: Patient groups

Study endpoints

Primary endpoint: Failure at 15 days after the first antibiotic intake (defined as temperature >37.9⁰C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause). Primary outcome according to the route of administration was evaluated.

Results

• The global failure rate was 26.5%
• The failure rate at Day 15 was not significantly different among patients treated with
  • Initial intravenous vs. oral treatment [26.9% vs. 26.2%, aOR 0.973; p 0.932)
  • 3GC vs. AMC treatment (1.7% vs. 28.6%, aOR 0.580; p=0.069)
  • Initial IV vs. exclusive oral AMC (36.4% vs. 26.2%, aOR 1.342; p = 0.267)
• Failure rates at Day 15 were not significantly different among two study groups in the subgroup populations:
  • Population with multi-lobar infection (23.8% vs. 41.7%, aOR 0.585, p 0.336)
  • Patients aged >65 years (32.7% vs. 33.3%, aOR 0.786, p 0.384)
  • Patients with pneumonia of CURB65 score of 3 or 4 (9.1% vs. 22.2%, aOR 0.25; p 0.110)

Conclusion

Among hospitalized patients with CAP, exclusive oral vs. initial IV antibiotic treatment, or initial treatment with IV 3GC vs. AMC no significant difference in efficacy

Reference

Clin Microbiol Infect. 2024 Aug;30(8):1020-1028