OBJECTIVE: To compare the effectiveness of discontinuing treatment with amoxicillin after three days or eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia who substantially improved after an initial three days' treatment. DESIGN: Randomised, double blind, placebo controlled non-inferiority trial. SETTING: Nine secondary and tertiary care hospitals in the Netherlands. PARTICIPANTS: Adults with mild to moderate-severe community acquired pneumonia (pneumonia severity index score < or = 110). INTERVENTIONS:Patients who had substantially improved after three days' treatment with intravenousamoxicillin were randomly assigned to oral amoxicillin (n = 63) or placebo (n = 56) three times daily for five days. MAIN OUTCOME MEASURES: The primary outcome measure was the clinical success rate at day 10. Secondary outcome measures were the clinical success rate at day 28, symptom resolution, radiological success rates at days 10 and 28, and adverse events. RESULTS: Baseline characteristics were comparable, with the exception of symptom severity, which was worse in the three day treatment group. In the three day and eight day treatment groups the clinical success rate at day 10 was 93% for both (difference 0.1%, 95% confidence interval--9% to 10%) and at day 28 was 90% compared with 88% (difference 2.0%,--9% to 15%). Both groups had similar resolution of symptoms. Radiological success rates were 86% compared with 83% at day 10 (difference 3%,--10% to 16%) and 86% compared with 79% at day 28 (difference 6%,--7% to 20%). Six patients (11%) in the placebo group and 13 patients (21%) in the active treatment group reported adverse events (P = 0.1). CONCLUSIONS:Discontinuing amoxicillin treatment after three days is not inferior to discontinuing it after eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia who substantially improved after an initial three days' treatment.
RCT Entities:
OBJECTIVE: To compare the effectiveness of discontinuing treatment with amoxicillin after three days or eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia who substantially improved after an initial three days' treatment. DESIGN: Randomised, double blind, placebo controlled non-inferiority trial. SETTING: Nine secondary and tertiary care hospitals in the Netherlands. PARTICIPANTS: Adults with mild to moderate-severe community acquired pneumonia (pneumonia severity index score < or = 110). INTERVENTIONS:Patients who had substantially improved after three days' treatment with intravenous amoxicillin were randomly assigned to oral amoxicillin (n = 63) or placebo (n = 56) three times daily for five days. MAIN OUTCOME MEASURES: The primary outcome measure was the clinical success rate at day 10. Secondary outcome measures were the clinical success rate at day 28, symptom resolution, radiological success rates at days 10 and 28, and adverse events. RESULTS: Baseline characteristics were comparable, with the exception of symptom severity, which was worse in the three day treatment group. In the three day and eight day treatment groups the clinical success rate at day 10 was 93% for both (difference 0.1%, 95% confidence interval--9% to 10%) and at day 28 was 90% compared with 88% (difference 2.0%,--9% to 15%). Both groups had similar resolution of symptoms. Radiological success rates were 86% compared with 83% at day 10 (difference 3%,--10% to 16%) and 86% compared with 79% at day 28 (difference 6%,--7% to 20%). Six patients (11%) in the placebo group and 13 patients (21%) in the active treatment group reported adverse events (P = 0.1). CONCLUSIONS: Discontinuing amoxicillin treatment after three days is not inferior to discontinuing it after eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia who substantially improved after an initial three days' treatment.
Authors: Guillermo Ortiz-Ruiz; Jose Caballero-Lopez; Ian R Friedland; Gail L Woods; Alexandra Carides Journal: Clin Infect Dis Date: 2002-03-18 Impact factor: 9.079
Authors: M S Niederman; L A Mandell; A Anzueto; J B Bass; W A Broughton; G D Campbell; N Dean; T File; M J Fine; P A Gross; F Martinez; T J Marrie; J F Plouffe; J Ramirez; G A Sarosi; A Torres; R Wilson; V L Yu Journal: Am J Respir Crit Care Med Date: 2001-06 Impact factor: 21.405
Authors: Stef L A M Bronzwaer; Otto Cars; Udo Buchholz; Sigvard Mölstad; Wim Goettsch; Irene K Veldhuijzen; Jacob L Kool; Marc J W Sprenger; John E Degener Journal: Emerg Infect Dis Date: 2002-03 Impact factor: 6.883
Authors: R Finch; D Schürmann; O Collins; R Kubin; J McGivern; H Bobbaers; J L Izquierdo; P Nikolaides; F Ogundare; R Raz; P Zuck; G Hoeffken Journal: Antimicrob Agents Chemother Date: 2002-06 Impact factor: 5.191
Authors: M Woodhead; F Blasi; S Ewig; J Garau; G Huchon; M Ieven; A Ortqvist; T Schaberg; A Torres; G van der Heijden; R Read; T J M Verheij Journal: Clin Microbiol Infect Date: 2011-11 Impact factor: 8.067
Authors: Alice Y Ho; Ase Ballangrud; Guang Li; Gaorav P Gupta; Beryl McCormick; Richard Gewanter; Daphna Gelblum; Melissa Zinovoy; Boris Mueller; Borys Mychalczak; Pinaki Dutta; Karen Borofsky; Preeti Parhar; Marsha Reyngold; Lior Z Braunstein; Mohit Chawla; Kate Krause; Natasha Freeman; Chun Ting Siu; Zachary Cost; Brittany B Arnold; Zhigang Zhang; Simon N Powell Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-30 Impact factor: 7.038
Authors: Paul Collini; Mike Beadsworth; Jim Anson; Tim Neal; Peter Burnham; Paul Deegan; Nick Beeching; Alastair Miller Journal: Postgrad Med J Date: 2007-08 Impact factor: 2.401
Authors: Anke H W Bruns; Jan Jelrik Oosterheert; Rachida El Moussaoui; Brent C Opmeer; Andy I M Hoepelman; Jan M Prins Journal: J Gen Intern Med Date: 2009-12-05 Impact factor: 5.128