Shortened Antibiotic Treatment of 5 Days in Community-Acquired Pneumonia
Shortened Antibiotic Treatment of 5 Days in Community-Acquired Pneumonia
CAP5 is an investigator-initiated multicentre non-inferiority randomized controlled trial
 which aims to assess the efficacy and safety of shortened antibiotic treatment duration of
 community-acquired pneumonia (CAP) in hospitalized adult patients based on clinical stability
 criteria.

 Five days after initiation of antimicrobial therapy for CAP, participants are randomized 1:1
 to parallel treatment arms: 5 days (intervention) or minimum 7 days (control) of antibiotic
 treatment. The intervention group discontinues antibiotics at day 5 if clinically stable and
 afebrile for at least 48 hours. The control group receives antibiotics for a duration of 7
 days or longer at the discretion of the treating physician.

 The primary outcome is 90-day readmission-free survival which will be tested with a
 non-inferiority margin of 6%.
Inclusion Criteria:

 -  Hospitalized with community-acquired pneumonia; defined as new pulmonary infiltrate on
 chest X-ray and at least one symptom compatible with pneumonia (cough, fever, dyspnoea
 and/or chest pain)

 -  Initiation of antibiotics within 12 hours of the time of the chest X-ray with an
 infiltrate

 -  Age ≥ 18 years

 -  Afebrile (temperature ≤ 37.8 °C) for 48 hours at randomization

 -  Clinically stable at randomization (systolic blood pressure ≥ 90 mm Hg, heart rate ≤
 100/min., respiratory rate ≤ 24/min., peripheral oxygen saturation ≥ 90%)

 Exclusion Criteria:

 -  Immunosuppression (HIV-positive, neutropenia, corticosteroid treatment (≥10 mg/day of
 prednisone or the equivalent for >30 days), chemotherapy, immunosuppressive agents,
 immunosuppressed after solid organ transplantation, asplenia)

 -  Hospitalization during the previous 14 days

 -  Antibiotic treatment (>2 days) within the past 30 days

 -  Uncommon cause requiring longer duration of antimicrobial therapy (Pseudomonas
 aeruginosa, Staphylococcus aureus, Mycobacterium spp., fungi)

 -  Extrapulmonary infection (e.g. endocarditis, meningitis, or abscess)

 -  Pleural empyema or lung abscess

 -  Pleural effusion requiring drainage tube

 -  Intensive care unit (ICU) admittance

 -  Pregnancy and breastfeeding