Here’s a quick question:
It depends ….. and I really haven’t given you all the required details for you to answer the question accurately. It depends on many factors including whether it is a community acquired pneumonia or hospital acquired pneumonia and / or whether the patient is in intensive care unit and would be at risk for ventilated associated pneumonia.
So what about nursing home associated pneumonia?
The IDSA/ATS guidelines in 2005 used to consider healthcare associated pneumonia (including nursing home associated pneumonia) to be managed as if they were the same as hospitalized acquired pneumonia. The rationale was that patients could be sicker, at higher risk for complications and also might be subject to multi-drug resistant organisms. But recently, this argument has been challenged and refuted.
The latest IDSA/ATS guideline released in 2016 no longer considers this to be the case. Healthcare associated pneumonia is now managed similar to community acquired pneumonia (unless the patient has other comorbidities that calls for a different approach e.g. aspiration pneumonia).
This opens up the question on the optimal duration of antibiotic therapy.
According to the American Guidelines from IDSA/ATS:
- Hospitalized Associated Pneumonia including Ventilated Associated Pneumonia should be treated for 7 days
- Community Acquired Pneumonia should be treated for 5 days and up to 7 days if required.
According to the Canadian Guidelines from Towards Optimized Practice (TOP), nursing home associated pneumonia should be treated for 7 days.
There are many advantages to treating pneumonia with a shorter duration including a reduced risk for developing antibiotic resistance, cost saving benefits, less impact from drug interactions and improved compliance.
I don’t think we currently have any overwhelming strong evidence to support treating nursing home associated pneumonia with 5 days of antibiotic therapy. But I think this is a practice that is worth exploring, especially with the recent focus of implementing antibiotic stewardship in long term care facilities.
I also wish we can engage more clinical research in long term care facilities to answer this specific question. After all, I don’t think it is difficult to set up a simple protocol to compare residents being treated with 5 days or 7 days of antibiotics for pneumonia and follow up with some meaningful outcomes. Unfortunately, there is generally a lack of funding/resources or infrastructure to conduct clinical research in this setting.
Let’s hope there will be more funding available for research activities in the coming days.