[Short course antibiotic treatment during community acquired pneumonia: Review of the literature and perspectives]

Abstract

Introduction: Community acquired pneumonia (CAP) accounts for a large part of antibiotic prescriptions in France. The significant ecological impact of antibiotics supports the development of strategies to improve their use, especially the reduction of treatment duration during CAP.

State of the art: During CAP, a strategy of early antibiotic discontinuation, subject to a favorable initial clinical course, or of a significantly decreasing procalcitonin kinetic, is supported by several studies. The reduction of antibiotic treatment duration leads to a decrease of the emergence of resistant bacteria. It may also be associated with a better treatment observance and a decrease in costs and side effects.

Perspectives: Diagnostic tests based on molecular biology, especially those including some bacterial targets in their panel, allow an increase on microbiological documentation rates during CAP. They should enable the elaboration of therapeutic strategies for a better use of the antibiotics.

Conclusions: These strategies of antibiotic treatment rationalization during CAP may be associated with a high benefit-risk ratio both at the individual and the community scales. Particularly, they may allow a substantial ecologic gain in this era of resistant bacteria.

Keywords: Anti-bacterial agents; Antibio-résistance; Antibiotiques; Drug resistance; Infections respiratoires; Pneumonia; Pneumonie; Respiratory tract infections.