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1 Supplementary Online Content Uranga A, España, Bilbao A, et al. Duration of antibiotic treatment in communityacquired pneumonia: a multicenter randomized clinical trial. JAMA Intern Med. ublished online July 25, doi: /jamainternmed etable 1. Vital Signs at Day 5 in the er-rotocol opulation etable 2. Distribution of Causative Microorganism in 63 atients With CA in the er- rotocol opulation etable 3. Results for rimary Study Outcomes by Type of Antibiotics etable 4. Results for rimary Study Outcomes by Hospitals etable 5. Results for Secondary Outcomes in Intent-to-Treat Analysis efigure. Kaplan-Meier Curves for Return to Normal Activity Until Day 30 in the Intentto-Treat (A) and the er-rotocol opulation (B) This supplementary material has been provided by the authors to give readers additional information about their work.
2 etable 1. Vital Signs at Day 5 in the er-rotocol opulation Body temperature, C 36.3 (0.5) 36.4 (0.7).43 Systolic blood pressure, mmhg Respiratory rate, breaths/min (24.8) (18.7) (5.0) 21 (3.0).10 Heart rate, beats/min 81.7 (17.2) 77.5 (13.4).26 Oxygen saturation, % 94.6 (2.8) 94.9 (2.1).92 All data are presented as. SD: standard deviation.
3 etable 2. Distribution of Causative Microorganism in 63 atients With CA in the er- rotocol opulation (n=35) (n=28) Streptococcus pneumonia 29 (82.9) 21 (75).44 Legionella pneumophila 4 (11.4) 7 (25).19 Haemophilus influenzae 1 (2.9) 0 (0) >.99 Escherichia coli 1 (2.9) 1 (3.6) >.99 Streptococcus pyogenes 1 (2.9) 0 (0) >.99 Coxiella burnetti 1 (2.9) 1 (3.6) >.99 Mycoplama 1 (2.9) 1 (3.6) >.99 Chlamydia 1 (2.9) 1 (3.6) >.99 Virus a 1 (2.9) 1 (3.6) >.99 All data are presented as number (percentage) of study participants. a The same patient was positive for more than one virus.
4 etable 3. Results for rimary Study Outcomes by Type of Antibiotics a Intention-to-treat er-protocol Quinolones alone or in combination (n=119) (n=128) (n=109) (n=117) At day (46.5) 71 (56.3) (48.1) 67 (58.2).13 At day (87.2) 117 (92.1) (91.6) 110 (94.8).34 CA-Symptom At day (11.7) 27.1 (12.0) (11.5) 26.8 (11.4).04 At day (9.3) 17.5 (7.4) (8.7) 17.4 (7.2).82 Beta-lactams + macrolides (n=11) (n=13) (n=10) (n=13) At day 10 6 (54.5) 10 (76.9).39 6 (60) 10 (76.9).65 At day (90.9) 12 (92.3) > (100) 12 (92.3) >.99 CA-Symptom At day (8.7) 24.0 (17.5) (9.0) 24.0 (17.5).60 At day (7.3) 14.8 (8.7) (6.2) 14.8 (8.7).62 Beta-lactams (n=20) (n=19) (n=18) (n=16) At day (57.8) 9 (47.3) (58.8) 9 (56.2).88 At day (95) 16 (88.8) (94.4) 14 (93.3) >.99
5 CA-Symptom At day 5 27 (11.2) 28.5 (11.1) (11.6) 27.5 (11.5).53 At day (7.6) 21.7 (6.4) (8.0) 21.1 (5.8).48 Abbreviation: CA, community-acquired pneumonia. a Data are presented as number (percentage) or. ercentages exclude patients with missing data. b On the CA symptom questionnaire score, which is a specific and validated patientreported outcome measure based on 18 items, higher scores indicated more severe CArelated symptoms (range: 0 to 90).
6 etable 4. Results for rimary Study Outcomes by Hospitals a Intention-to-treat er-protocol HOSITAL A (n=65) (n=81) (n=61) (n=75) At day (67.6) 58 (72.5) (70.4) 58 (78.3).29 At day (92.3) 75 (93.7) (96.7) 71 (95.9) >.99 CA-Symptom At day (12.6) 30.5 (15.2) (12.2) 29.3 (14.8).13 At day (8.9) 15.9 (7.5) (7.1) 15.6 (7.5).36 HOSITAL B (n=49) (n=37) (n=42) (n=29) At day (41.3) 19 (52.7) (41.0) 16 (57.1).19 At day (87.5) 32 (88.8) > (90.2) 27 (96.4).64 CA-Symptom At day (9.7) 27.6 (6.9) (10.2) 27.5 (7.0).75 At day (7.0) 24.5 (4.7) (7.5) 24.1 (4.1).64 HOSITAL C (n=26) (n=37) (n=26) (n=36) At day 10 6 (24) 10 (27.0).79 6 (24) 10 (27.7).74 At day (84.6) 33 (89.1) (84.6) 32 (88.8).71
7 CA-Symptom At day (7.7) 21.1 (6.6) (7.7) 21.4 (6.5).04 At day (7.8) 17.4 (6.2) (7.8) 17.7 (5.9).62 HOSITAL D (n=10) (n=7) (n=8) (n=6) At day 10 2 (20) 3 (42.8).59 2 (25) 2 (33.3) >.99 At day 30 8 (80) 7 (100).49 8 (100) 6 (100) >.99 CA-Symptom At day (9.9) 19.4 (8.3) (10.4) 21 (7.9).66 At day (10.8) 11.5 (6.6) (10.3) 12.3 (6.8).32 Abbreviation: CA, community-acquired pneumonia. a Data are presented as number (percentage) or. ercentages exclude patients with missing data. b On the CA symptom questionnaire, which is a specific and validated patient-reported outcome measure based on 18 items, higher scores indicated more severe CA-related symptoms (range: 0 to 90).
8 etable 5. Results for Secondary Outcomes in Intent-to-Treat Analysis a Time, median (IQR), d (n=150) (n=162) Taking antibiotics 10 (10-11) 5 (5-9) <.001 Not taking antibiotics 21 (10-27) 25 (5-31).0011 Taking intravenous antibiotics 2 (2-4) 3 (2-4).24 Until clinical improvement, median (IQR) Return to normal activity, median (IQR) 12 (8 18) 12 (8 15) (9 24) 15 (10 21).58 Radiographic resolution at day (66.4) 122 (79.2).01 In-hospital mortality 2 (1.3) 3 (1.8) > Day mortality 3 (2) 3 (1.8) >.99 Recurrence by day 30 6 (4) 4 (2.4).53 Readmission by day (6.7) 2 (1.8).03 In-hospital complications leural effusion 11 (7.3) 6 (3.7).16 Treatment failure b 3 (2) 3 (1.8) >.99 Respiratory failure c 26 (17.3) 32 (19.7).58 Severe Sepsis d 7 (4.6) 11 (6.7).42 Renal failure e 5 (3.3) 8 (4.9).49 ICU admission 2 (1.3) 1 (0.6).61 Use of invasive mechanical ventilation Use of non-invasive mechanical ventilation 2 (1.3) 1 (0.6).61 3 (2.0) 2 (1.2).67 Need for vasopressors 2 (1.3) 3 (1.8) >.99 Antibiotic adverse effects by day (12.6) 18 (11.1).69
9 Time with antibiotic adverse effects,, d Length of hospital stay,, d 3 (2.7) 1.6 (2.0) (3.0) 5.8 (2.7).71 Abbreviations: ICU, intensive care unit; IQR, interquartile range- a Data are presented as number (percentage) of study participants unless otherwise indicated. ercentages exclude patients with missing data. b Treatment failure was defined as clinical deterioration based on the presence of any of the following: hemodynamic instability, demonstrated respiratory failure or the appearance of it, need for mechanical ventilation, demonstrated radiographic progression of pneumonia or the appearance of a new infectious foci and absence or delay in achieving clinical stability after first 72 hours. c Respiratory failure was defined as ao 2 to fraction of inspired oxygen ratio less than 250 mmhg. d Severe Sepsis was defined as sepsis associated with organ dysfunction and perfusion abnormalities. One of the following criteria had to be met: ph less than 7.30, systolic blood pressure less than 90 mmhg, pneumonia associated altered mental status, ao 2 to fraction of inspired oxygen ratio less than 250 mmhg, acute renal failure >2 mg/dl (to convert to micromoles per liter, multiply by 88.4), disseminated intravascular coagulopathy or hematocrit less than 25%. e Renal failure was defined as a creatinine greater than 2 mg/dl (to convert to micromoles per liter, multiply by 88.4).
10 efigure. Kaplan-Meier Curves for Return to Normal Activity Until Day 30 in the Intentto-Treat (A) and the er-rotocol opulation (B) A) B) Intention-to-treat er-protocol Cumulative event free outcome Cumulative event free outcome Days Days The log-rank test did not detect statistically significant differences between the two s (control receiving conventional treatment and intervention receiving antibiotic treatment with duration based on IDSA/ATS criteria; p=.38 in the intention-to trait and p=.16 in the per-protocol population).
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