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Penicillin V as first-line treatment of pneumonia in primary care : a registry-based study

Cronberg, Olof LU orcid ; Tyrstrup, Mia LU ; Beckman, Anders LU orcid ; Carlsson, Sara ; Ekblom, Kim LU ; Moberg, Anna and Hedin, Katarina LU (2025) In Clinical Microbiology and Infection p.1-8
Abstract

OBJECTIVES: Penicillin V (PcV) is considered the first-line treatment for community-acquired pneumonia in Scandinavian countries, although data supporting this recommendation are scarce. Thus, this study aimed to compare PcV and amoxicillin regarding the risk of treatment failures in children aged >5 years and adults treated for pneumonia in primary care.

METHODS: In this retrospective study of healthcare registry data from four regions in Sweden with 2.3 million inhabitants, we included 34 306 primary care cases of pneumonia from February 12, 2018 to December 3, 2021. Adjusted odds ratios (aORs) and 95% CIs for treatment failure days 1 to 28 (primary composite endpoint: hospitalization for lower respiratory tract infections... (More)

OBJECTIVES: Penicillin V (PcV) is considered the first-line treatment for community-acquired pneumonia in Scandinavian countries, although data supporting this recommendation are scarce. Thus, this study aimed to compare PcV and amoxicillin regarding the risk of treatment failures in children aged >5 years and adults treated for pneumonia in primary care.

METHODS: In this retrospective study of healthcare registry data from four regions in Sweden with 2.3 million inhabitants, we included 34 306 primary care cases of pneumonia from February 12, 2018 to December 3, 2021. Adjusted odds ratios (aORs) and 95% CIs for treatment failure days 1 to 28 (primary composite endpoint: hospitalization for lower respiratory tract infections [LRTI] or all-cause mortality; and secondary endpoint: antibiotic switch) were calculated using logistic regression analysis. A propensity score matched analysis was conducted.

RESULTS: PcV was prescribed in 19 761 cases, amoxicillin in 2363 cases, doxycycline in 9830 cases, and other antibiotics in 2352 cases. Hospitalization for LRTI or all-cause mortality occurred in 4.9% of cases treated with amoxicillin vs. 3.8% of cases treated with PcV (aOR, 1.07; 95% CI, 0.87-1.32). Antibiotic switch occurred in 8.9% of cases treated with amoxicillin vs. 14% of cases treated with PcV (aOR, 0.58; 95% CI, 0.50-0.67). The corresponding ORs of the propensity score match analysis were 1.13 (95% CI, 0.86-1.49) for hospitalization for LRTI or all-cause mortality and 0.55 (95% CI, 0.45-0.65) for antibiotic switch.

CONCLUSIONS: This study showed no difference in risks of hospitalization for LRTI or all-cause mortality between PcV and amoxicillin for pneumonia in primary care.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Clinical Microbiology and Infection
pages
1 - 8
publisher
Wiley-Blackwell
external identifiers
  • scopus:105016495144
  • pmid:40854461
ISSN
1469-0691
DOI
10.1016/j.cmi.2025.08.016
language
English
LU publication?
yes
additional info
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
id
fe82c19d-9878-4378-9b52-b6b1d845153a
date added to LUP
2025-10-28 09:55:38
date last changed
2025-10-29 04:01:07
@article{fe82c19d-9878-4378-9b52-b6b1d845153a,
  abstract     = {{<p>OBJECTIVES: Penicillin V (PcV) is considered the first-line treatment for community-acquired pneumonia in Scandinavian countries, although data supporting this recommendation are scarce. Thus, this study aimed to compare PcV and amoxicillin regarding the risk of treatment failures in children aged &gt;5 years and adults treated for pneumonia in primary care.</p><p>METHODS: In this retrospective study of healthcare registry data from four regions in Sweden with 2.3 million inhabitants, we included 34 306 primary care cases of pneumonia from February 12, 2018 to December 3, 2021. Adjusted odds ratios (aORs) and 95% CIs for treatment failure days 1 to 28 (primary composite endpoint: hospitalization for lower respiratory tract infections [LRTI] or all-cause mortality; and secondary endpoint: antibiotic switch) were calculated using logistic regression analysis. A propensity score matched analysis was conducted.</p><p>RESULTS: PcV was prescribed in 19 761 cases, amoxicillin in 2363 cases, doxycycline in 9830 cases, and other antibiotics in 2352 cases. Hospitalization for LRTI or all-cause mortality occurred in 4.9% of cases treated with amoxicillin vs. 3.8% of cases treated with PcV (aOR, 1.07; 95% CI, 0.87-1.32). Antibiotic switch occurred in 8.9% of cases treated with amoxicillin vs. 14% of cases treated with PcV (aOR, 0.58; 95% CI, 0.50-0.67). The corresponding ORs of the propensity score match analysis were 1.13 (95% CI, 0.86-1.49) for hospitalization for LRTI or all-cause mortality and 0.55 (95% CI, 0.45-0.65) for antibiotic switch.</p><p>CONCLUSIONS: This study showed no difference in risks of hospitalization for LRTI or all-cause mortality between PcV and amoxicillin for pneumonia in primary care.</p>}},
  author       = {{Cronberg, Olof and Tyrstrup, Mia and Beckman, Anders and Carlsson, Sara and Ekblom, Kim and Moberg, Anna and Hedin, Katarina}},
  issn         = {{1469-0691}},
  language     = {{eng}},
  month        = {{08}},
  pages        = {{1--8}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Microbiology and Infection}},
  title        = {{Penicillin V as first-line treatment of pneumonia in primary care : a registry-based study}},
  url          = {{http://dx.doi.org/10.1016/j.cmi.2025.08.016}},
  doi          = {{10.1016/j.cmi.2025.08.016}},
  year         = {{2025}},
}