[Reducing the duration of antibiotic therapy in acute community-acquired pneumonia]

Abstract

In theory, the expected benefits of a reduction of the duration of antibiotic therapy during the immunocompetent adult's community-acquired pneumonia (CAP) are of four types: improved observance; reduction of the iatrogenic risk; decrease in the emergence of resistance in the commensal flora; reduction in direct and indirect costs. In practice, the expected benefits must be weighed against the risks of lesser efficiency, i.e., continuing evolution or recurrence. The experimental models of humanized pneumonia treatments show that the period of bacterial eradication is not uniform. If it lasts 48 hours for pneumonia with sensitive pneumococci, it is longer for pneumococci resistant to amoxicillin or atypical bacteria. Thus, if the clinical trials conducted in adults with non-severe CAP, have shown that the duration of treatment could be reduced, depending on the existence or not of a comorbidity, to a 3 days amoxicillin treatment, to a 5 days telithromycin treatment, to a 5 days of levofloxacin 750 mg/day treatment or to a 5 days of ceftriaxone 1g / day treatment, it is logical to assume that such reductions cannot be extrapolated to severe unqualified PACs with severe or to those caused by resistant bacteria or atypical bacteria.