Time to antibiotics administration and outcome in community-acquired pneumonia: Secondary analysis of a randomized controlled trial


      • Guidelines do not assign a specific time frame for the first antibiotic dose in CAP
      • We evaluated the benefit of early antibiotics in moderately severe pneumonia
      • Time to treatment was not associated with a shorter time to clinical stability
      • These results should not be extrapolated to patients with more severe disease



      The association between early antibiotic administration and outcomes remains controversial in patients hospitalized for community-acquired pneumonia.


      We performed a secondary analysis of a randomized controlled trial comparing two antibiotic treatment strategies for patients hospitalized for moderately severe CAP. The univariate and multivariate associations between time to antibiotic administration (TTA) and time to clinical stability were assessed using a Cox proportional hazard model. Secondary outcomes were death, intensive care unit admission and hospital readmission up to 90 days.


      371 patients (mean age 76 years, CURB-65 score ≥ 2 in 52%) were included. Mean TTA was 4.35 h (SD 3.48), with 58.5% of patients receiving the first antibiotic dose within 4 h.
      In multivariate analysis, number of symptoms and signs (HR 0.876, 95% CI 0.784–0.979, p = 0.020), age (HR 0.986, 95% CI 0.975–0.996, p = 0.007), initial heart rate (HR 0.992, 95% CI 0.986–0.999, p = 0.023), and platelets count (HR 0.998, 95% CI 0.996–0.999, p = 0.004) were associated with a reduced probability of reaching clinical stability. The association between TTA and time to clinical stability was not significant (HR 1.009, 95% CI 0.977–1.042, p = 0.574). We found no association between TTA and the risk of intensive care unit admission, death or readmission up to 90 days after the initial admission.


      In patients hospitalized for moderately severe CAP, a shorter time to antibiotic administration was not associated with a favorable outcome. These findings support the current recommendations that do not assign a specific time frame for antibiotics administration.


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