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Short-Course CAP Evidence — SCE Infectious Diseases MCQ

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EasyRespiratory InfectionShort-Course CAP EvidenceSCE Infectious Diseases

A 55-year-old man with COPD develops a community-acquired pneumonia. His GP prescribes Amoxicillin 500 mg TDS for 5 days per NICE guidelines. The patient asks why the course is only 5 days when he was previously given 7 days. What evidence supports the shorter course?

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Correct answer: E — Multiple RCTs and meta-analyses show that 5 days of antibiotics for low-moderate severity CAP (when clinically improving) is non-inferior to longer courses — shorter courses reduce adverse effects and resistance selection

NICE NG138 (2023) recommends 5 days total antibiotic duration for low- and moderate-severity CAP. This is supported by multiple RCTs and meta-analyses demonstrating non-inferiority of shorter courses when clinical improvement occurs. The shift toward shorter courses reflects robust evidence that prolonged antibiotics do not improve outcomes but increase C. difficile risk, side effects, and antimicrobial resistance. Extension beyond 5 days is appropriate for: no clinical improvement, severe CAP, specific pathogens requiring longer treatment (Legionella, S. aureus), or complications.

Reference: NICE NG138 2023 – Pneumonia; Cochrane 2021 – Short-course CAP