Short courses of antibiotics appear just as effective as longer ones, and a great deal safer, in managing respiratory infections that might cause pneumonia in children treated with temporary breathing devices, according to a Johns Hopkins Children’s Center study published online this month in Clinical Infectious Diseases.
In the studys analysis of 150 children receiving antibiotics for respiratory infections while supported on a ventilator, longer antibiotic courses not only failed to confer extra protection against full-blown pneumonia when compared with shorter therapy, but also considerably increased a childs risk for developing drug-resistant infections within a month.
To rein in the spread of bacterial drug resistance, the researchers advise clinicians to carefully evaluate the need for antibiotics in the first place and to use antibiotics for the shortest time needed to achieve clinical effect.
Our study underscores the old physician maxim to first do no harm, said lead investigator Pranita Tamma, MD, an infectious disease specialist at the Johns Hopkins Children’s Center. Longer treatment is not always more effective, and it could be downright dangerous.
Children supported by ventilators often develop respiratory infections because the endotracheal tubes allow bacteria an easy entry into the respiratory tract. These children need antibiotics promptly to prevent the infection from spreading into the lungs, but the optimal length of treatment has been unclear.
We hope that our findings will help clear up some of the confusion and discourage physicians from preemptively opting for longer treatments, Tamma said.
The Johns Hopkins investigators analyzed three years of medical records involving more than 1,600 children, age 18 and younger, who spent at least two days intubated. Of the patients, 150 received antibiotics for ventilator-related upper respiratory infections; only 118 met clinical criteria for such infections, while 32 were treated merely on suspicion of infection.
Of the 82 children with actual infections who were treated with antibiotics for more than a week, 23% developed pneumonia, compared to 20% of the 36 children who received antibiotics for seven days or fewer. Children who received the lengthy antibiotic course were five times more likely, on average, to develop drug-resistant infections following the treatment. Children who received multiple antibiotics were three times as likely to do so.
Although the length of antibiotic use made no statistical difference in pneumonia risk, the length of intubation did. Children whose tubes were left in after diagnosis of infection and start of therapy were four times more likely to progress to pneumonia than children weaned from the ventilator promptly after diagnosis and start of treatment, the researchers found.
The finding emphasizes the need for careful daily reassessment of each childs need for respiratory support with a ventilator, they added.