Kok, Hing C. and McCallum, Gabrielle B. and Yerkovich, Stephanie T. and Grimwood, Keith and Fong, Siew M. and Nathan, Anna M. and Byrnes, Catherine A. and Ware, Robert S. and Nachiappan, Nachal and Saari, Noorazlina and Morris, Peter S. and Yeo, Tsin W. and Oguoma, Victor M. and Masters, I. Brent and de Bruyne, Jessie A. and Eg, Kah P. and Lee, Bilawara and Ooi, Mong H. and Upham, John W. and Torzillo, Paul J. and Chang, Anne B. (2024) Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-risk Settings: A Randomized Controlled Trial. Pediatric Infectious Disease Journal, 43 (9). pp. 872-879. ISSN 0891-3668, DOI https://doi.org/10.1097/INF.0000000000004407.
Full text not available from this repository.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.
| Item Type: | Article |
|---|---|
| Funders: | National Health & Medical Research Council (NHMRC) of Australia (1098443) ; (1040830), Cure-Kids, New Zealand (3571), University of Malaya Research Grant (RP026-14HTM), Charles Darwin International PhD Scholars (CDIPS) Scholarship, National Health & Medical Research Council (NHMRC) of Australia (2025379), Senior Practitioner Fellowship (1154302) |
| Uncontrolled Keywords: | hospitalized pneumonia; long-term effects; antibiotic duration; controlled trials; child |
| Subjects: | R Medicine > RJ Pediatrics |
| Divisions: | Faculty of Medicine > Paediatrics Department |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 12 Feb 2025 08:09 |
| Last Modified: | 12 Feb 2025 08:09 |
| URI: | http://eprints.um.edu.my/id/eprint/47477 |
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