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Shorter-course Amoxicillin for Pneumonia: Safe and Effective

A three-day course of amoxicillin is as effective as the standard 7-10-day course in combating common pneumonia, according to Dutch researchers. The shorter treatment time may also help to contain the increasing public health problem of antibiotic-resistant bacteria.

The study by R el Moussaoui et al was published in the June 10 issue of the British Medical Journal and reported by

"The question is how long you should treat common pneumonia," said researcher Dr Jan M Prins, an internist in infectious diseases at the Academic Medical Center in Amsterdam. "It turns out that three days is sufficient in children, and we now find the same in adults," he reportedly added.

Clinical Trial

In the study, Dr Prins and colleagues compared the effectiveness of amoxicillin treatment taken for three days versus eight days in adults with mild to moderate-severe pneumonia.

The study pool consisted of 119 people with pneumonia who improved after three days' treatment with intravenous amoxicillin. These participants were then randomly assigned to receive oral amoxicillin (or placebo) for a further five days.

Of the participants who received amoxicillin for either three or eight days (three days initial treatment plus five more days' treatment), 93% improved.

"For patients who responded after three days of antibiotic treatment, you could stop antibiotics and the results were comparable for those treated for eight days," Dr Prins reportedly said.

Shorter treatment time means patients take no more antibiotics than they need, which translates into reduced risk of developing resistant bacteria: "In addition, there is a relation between how many antibiotics are used in a community and the rate of resistance among bacteria," Dr Prins noted. "If you can reduce the use of antibiotics, you can reduce the rate of resistance."

Dr Prins cautioned that not all diseases treated with antibiotics will be candidates for short-course treatment. "In other conditions, we know you have to treat for 10 days or so," he said.

Editorial Comments

In an accompanying editorial, Dr John Paul, from the Royal Sussex County Hospital, in England, noted that more research is needed about the ideal duration of antibiotic treatments.

"There is a lack of clear evidence to allow clinicians to know the optimal duration of antibiotic therapy for many common infections," Dr Paul reportedly said. "We know that some infections do require long-term therapy to prevent relapse. We know for others that short courses of antibiotics are as good as long courses."

"Although the consensus among microbiology/infectious disease specialists is that long-course therapy is the choice, you will still find plenty of clinicians who use personal experience to argue for short-course therapy," he reportedly said.

Short-course treatment has merit, according to another expert.

"This concept is smart," said Philip Tierno Jr, director of clinical microbiology and immunology at New York University Medical Center, according to "It eliminates three big problems: The cost to individuals of some of these newer antibiotics, adverse reactions and complications, and the development of resistance."

Sources: Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. R el Moussaoui, British Medical Journal, volume 332, page1355, June 10, 2006. Shorter Course of Antibiotics Effective for Pneumonia,, June 8, 2006. What is the optimal duration of antibiotic therapy? J Paul, British Medical Journal, volume 332, June 10, 2006.

Posted: June 2006