title: Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study.
abstract: 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.
  
  
  METHODS
  Randomised, double blind, placebo controlled non-inferiority trial.
  
  
  METHODS
  Nine secondary and tertiary care hospitals in the Netherlands.
  
  
  METHODS
  Adults with mild to moderate-severe community acquired pneumonia (pneumonia severity index score < or = 110).
  
  
  METHODS
  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.
  
  
  METHODS
  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.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Rachida
authors.initials: R
authors.lastname: el Moussaoui
authors.forename: Corianne A J M
authors.initials: CA
authors.lastname: de Borgie
authors.forename: Peterhans
authors.initials: P
authors.lastname: van den Broek
authors.forename: Willem N
authors.initials: WN
authors.lastname: Hustinx
authors.forename: Paul
authors.initials: P
authors.lastname: Bresser
authors.forename: Guido E L
authors.initials: GE
authors.lastname: van den Berk
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: Bob
authors.initials: B
authors.lastname: van den Berg
authors.forename: Frans H
authors.initials: FH
authors.lastname: Krouwels
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.forename: Carla
authors.initials: C
authors.lastname: Weenink
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Peter
authors.initials: P
authors.lastname: Speelman
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin