The optimal antibiotic treatment duration for community-acquired pneumonia in adults diagnosed in general practice in Denmark (CAP-D): an open-label, pragmatic, randomised controlled trial.

Autor: Johansen E; Center for General Practice, Aalborg University, Aalborg, Denmark. ejoha@dcm.aau.dk., Nielsen H; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Gillespie D; Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, UK., Aabenhus R; The Research Unit for General Practice, Copenhagen, Denmark.; Section of General Practice, Institute of Public Health, Copenhagen University, Copenhagen, Denmark., Hansen MP; Center for General Practice, Aalborg University, Aalborg, Denmark.; Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
Jazyk: angličtina
Zdroj: Trials [Trials] 2024 Sep 27; Vol. 25 (1), pp. 627. Date of Electronic Publication: 2024 Sep 27.
DOI: 10.1186/s13063-024-08477-z
Abstrakt: Background: Use of antibiotics is the main driver of antimicrobial resistance which is considered one of the biggest threats to human health. In Denmark, most antibiotics are prescribed in general practice. Acute lower respiratory tract infections, including community-acquired pneumonia (CAP), are among the most frequent indications for antibiotic prescribing. Phenoxymethylpenicillin is established as first-line treatment in general practice in Denmark. However, the treatment duration with phenoxymethylpenicillin is mostly based on traditions. Both 5 and 7 days of treatment is recommended in Danish guidelines, and when asking the general practitioners about what treatment duration, they prescribe the variation is even bigger. Several hospital-based studies have proven short course (≤ 6 days) antibiotic treatment non-inferior to long course (≥ 7 days) treatment of CAP. No evidence exists on the optimal treatment duration for CAP in non-hospitalised patients. This randomised controlled trial aim to investigate the optimal treatment duration with phenoxymethylpenicillin for CAP in adults diagnosed in general practice in Denmark.
Methods: This is an open-label, pragmatic, randomised controlled, five-arm DURATIONS trial. Participants will be recruited from at least 24 general practices in Denmark. Eligible participants are adults, with no pre-existing lung disease, presenting with symptoms of CAP, and in whom the general practitioner finds it relevant to treat with antibiotics. The study will compare treatment with phenoxymethylpenicillin 1.2 MIE q.i.d. in 3, 4, 5, 6, and 7 days.
Discussion: This study will provide evidence for the optimal antibiotic treatment duration of CAP in general practice and inform future guidelines on CAP in all countries using phenoxymethylpenicillin for the treatment of acute respiratory tract infections in adults. The results of this study might also be used to guide treatment recommendations in other countries using phenoxymethylpenicillin. Moreover, a (potential) reduction in antibiotic use might lower the development of antimicrobial resistance, increase patient treatment adherence, reduce risks of adverse events, and lower the economical exp TRIAL REGISTRATION: ClinicalTrials.gov: NCT06295120. Registered 28 February 2024.  The Scientific Ethics Committee for the North Denmark Region: N-20230039.
(© 2024. The Author(s).)
Databáze: MEDLINE
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