Shorter antibiotic treatment durations may be as safe and effective as longer ones for a small subset of patients hospitalized with community-acquired pneumonia (CAP), researchers reported this week in the Annals of Internal Medicine.

For the study, a team led by researchers at the University of Michigan Medical School analyzed data from 67 Michigan hospitals from 2017 through 2024 to compare outcomes in hospitalized CAP patients with shorter versus longer antibiotic courses. The patients had to have received at least three days of antibiotics and to have achieved clinical stability by day 3. 

Using an emulated target trial design, the researchers evaluated which CAP patients would qualify for short-course therapy, then compared 30-day all-cause mortality, hospital readmission, urgent care visits, and Clostridioides difficile infections in CAP patients who received 0 to one additional days of antibiotics (three to four days total) versus those who received two or more additional days (five or more days).

Only 10% of patients met eligibility criteria

Among the 55,517 patients hospitalized with CAP over the study period, only 5,620 (10.1%) met the eligibility criteria for short-course therapy, with most being excluded because of underlying comorbidities. The median age of eligible patients was 68.2 years, and 54.3% were men. Of those patients, only 7.9% received three-to-four days of antibiotics, and the median antibiotic duration was 7 days. 

Thirty-day adjusted risk ratios for short- versus long-course antibiotic therapy were 0.89 for mortality, 1.07 for readmission, 0.94 for urgent visit, and 1.01 for C difficile infection. Adverse events were similar in both groups.

The study authors say the results are most applicable to non-intensive care unit CAP patients who are clinically stable after three days. But the study has identified critical research questions, they add.

“Given that 90% of patients were excluded, we need additional pragmatic, real-world data on the safety and efficacy of shorter antibiotic courses in higher-risk patients, such as those with more severe CAP, immunosuppression, multiple comorbidities, or persistent vital sign abnormalities,” they wrote.

Despite the wide availability of tetanus vaccines, US cases of the life-threatening disease continue to occur among people of all ages, especially those who are unvaccinated or undervaccinated, but at low levels, Centers for Disease Control and Prevention (CDC) researchers report.

The study, published today in Morbidity and Mortality Weekly Report, was based on case data from the National Notifiable Diseases Surveillance System from 2009 to 2023.

“Tetanus is a serious vaccine-preventable disease caused by the toxin produced by Clostridium tetani, a spore-forming bacterium that is ubiquitous in the environment,” the authors wrote. “Tetanus is not transmitted person-to-person; exposure usually occurs through a contaminated or deep wound,” causing symptoms such as muscle spasms, rigidity, difficulty swallowing or breathing, lockjaw, and seizures.

45% with wound sought care before disease onset

During the study period, 402 tetanus infections and 37 deaths were reported from 47 states and Washington, DC, for an average annual incidence of 0.08 cases and 0.008 deaths per 1 million people. 

Tetanus is a serious vaccine-preventable disease caused by the toxin produced by Clostridium tetani, a spore-forming bacterium that is ubiquitous in the environment.

Over half (62.2%) of cases occurred in males, who had a higher incidence than women among patients older than 65 years, but rates were higher in women than men for those aged 80 and older (0.27 cases per 1 million people). The case-fatality rate among patients with known vital status was 12.4% (37 of 299), with deaths primarily in older adults. 

In total, 45.0% of tetanus patients with a substantial wound sought care before symptom onset. Among those with wounds eligible for tetanus post-exposure prevention, only 2.3% received tetanus immune globulin (TIG), and 26% received tetanus toxoid–containing vaccine (TTCV). Among patients with known vaccination history, 43.9% hadn’t received any TTCV doses.

The researchers urged clinicians to evaluate for and offer routine tetanus vaccination for children, as well as 10-year boosters for adults. “In addition, persons with significant wounds should seek timely medical care, and clinicians should provide recommended wound care, including identifying tetanus-prone wounds and the need for and administration of TTCV and TIG.”

They called for continued surveillance and vaccination efforts to monitor trends, prevent tetanus, and reduce incidence.