▴ El Moussaoui R, de Borgie CA, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ2006;332;1355–8OpenUrlAbstract/FREE Full Text

This Dutch study, undertaken between November 2000 and July 2003, took adults with a pneumonia severity index score of ⩽110 and randomly assigned those who substantially improved after 72 hours of intravenous amoxicillin to either 750 mg oral amoxicillin (n = 63) or placebo (n = 56) three times daily for 5 days thereafter.

Clinical, bacteriological and radiological outcomes were assessed. The clinical success rate at day 10 (per protocol analysis) was 93% in both groups (50/54 in the 3 day treatment group and 56/60 in the 8 day treatment group: difference 0.1% (95% CI −9 to 10)). At day 28 clinical success rates were 90% (47/52) in the 3 day treatment group and 88% (49/56) in the 8 day treatment group (difference 2% (95% CI −9 to 15)). There was therefore little difference between the two groups.

This study suggests that a short course of antibiotic therapy is not inferior to a longer course in patients with mild to moderate-severe uncomplicated community acquired pneumonia who show clinical improvement after 3 days of intravenous antibiotics.