Stewardship / Resistance Scan for Nov 02, 2021

Lower antibiotic dose for kids' pneumonia
Antibiotic stewardship in urology patients

Trial supports low-dose, short-course antibiotics for kids' pneumonia

Among children with community-acquired pneumonia (CAP) who were discharged from the hospital within 48 hours but required further outpatient treatment, a lower dose of oral amoxicillin was non-inferior to a higher dose, and a 3-day duration was non-inferior to 7 days, according to the results of a randomized clinical trial published today in JAMA.

In the CAP-IT trial, conducted in 28 hospitals in the United Kingdom and 1 in Ireland, investigators enrolled children ages 6 months and older who were diagnosed as having CAP, had been discharged from a hospital ward or emergency department, and were set to receive a course of amoxicillin and randomly assigned them to four treatment groups: 35 to 50 milligrams per kilogram per day (mg/kg/d) of amoxicillin for 3 days, 35 to 50 mg/kg/d for 7 days, 70 to 90 mg/kg/d for 3 days, and 70 to 90 mg/kg/d for 7 days. The aim was to determine the optimal amoxicillin dose to minimize antibiotic exposure while achieving high clinical cure rates.

A total of 824 children (median age, 2.5 years) were randomized into one of the four groups. The primary outcome was clinically indicated antibiotic retreatment at 28 days post-randomization. The non-inferiority margin was 8%. Secondary outcomes included severity/duration of nine parent-reported CAP symptoms.

The primary outcome occurred in 12.6% of children who received the lower dose compared with 12.4% of those who received the higher dose and in 12.5% who received 3 days of amoxicillin versus 12.5% who received 7 days. Both the lower-dose and shorter-duration groups achieved statistical non-inferiority with no significant interaction between dose and duration. Among a subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment.

For the secondary end points, cough persisted longer in children who received 3 days of treatment compared with 7 days (median 10 days vs 12 days; hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.0 to 1.4), but sleep disturbed by cough was similar (median 4 days vs 4 days; HR, 1.2; 95% CI, 1.0 to 1.4).
Nov 2 JAMA abstract


Urology stewardship linked to drops in antibiotic use, costs, resistance

Antibiotic stewardship interventions for urology outpatients at a Japanese hospital contributed to reducing the use of broad-spectrum agents, reducing yearly antibiotic costs, and improving susceptibilities in certain bacteria, researchers reported yesterday in the American Journal of Infection Control.

Using data on 2,739 urology outpatients with lower urinary tract infection (UTI) symptoms who were treated at a rehabilitation hospital from 2011 through 2020, the researchers compared antimicrobial use density (AUD), antimicrobial agent costs, and antimicrobial susceptibility in UTI-causing bacteria during two different periods of antibiotic use oversight at the hospital: the infection control team (ICT) era (pre-2014), and the antibiotic stewardship program (ASP) era (post-2014).

ASP interventions included asking urologists to consider discontinuing broad-spectrum antibiotics, such as third-generation cephalosporins and quinolones, and to prescribe more specific antibiotics for shorter periods.

The analysis found that, during the ASP era, overall AUD and AUD for individual antibiotics, including second-generation cephalosporins, cefotiam, cefdinir, levofloxacin, sitafloxacin, and tosufloxacin, showed significant decreases, as did overall and individual antimicrobial agent costs. In a median comparison, there was an overall 49% decrease in antimicrobial costs, with particularly large decreases for broad-spectrum antimicrobials. Regarding drug susceptibility among UTI-causing pathogens, Escherichia coli showed increased susceptibility to cefotiam, levofloxacin, and sulfamethoxazole/trimethoprim during the ASP era, and Klebsiella pneumoniae showed increased susceptibility to minocycline.

"Appropriate interventions have shown to reduce antibiotic use, antibiotic resistance, and health care costs," the study authors wrote. "Further prospective studies with a wider patient cohort need to be performed to draw more definitive conclusions."
Nov 1 Am J Infect Control abstract

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