TOPLINE:

Penicillin V was as effective as amoxicillin for treating pneumonia in primary care, with similar rates of hospitalisation for lower respiratory tract infection or all-cause mortality within 28 days of starting antibiotic therapy, making it a viable alternative in primary care settings with similar resistance patterns.

METHODOLOGY:

• Researchers in Sweden conducted a retrospective cohort study to compare treatment failure rates between penicillin V and amoxicillin in 34,306 patients including children older than 5 years and adults with pneumonia (53% female) who attended primary care from February 2018 to December 2021.
• Data on primary care consultations, hospitalisations, and antibiotic prescriptions for all pneumonia visits at public and private healthcare centres were obtained from linked healthcare registries.
• The primary outcome was hospitalisation for lower respiratory tract infection or all-cause mortality within 1-28 days of starting antibiotic therapy.
• Secondary outcomes included any antibiotic switch, defined as prescriptions of a different antibiotic within 1-28 days before possible hospitalisation.

TAKEAWAY:

• Overall, 58% of patients received penicillin V, 29% received doxycycline, 6.9% received amoxicillin, and 6.9% received other antibiotics; the highest rate of hospitalisation for lower respiratory tract infection or all-cause mortality was observed in the amoxicillin group compared with that in the penicillin V group (4.9% vs 3.8%).
• Hospitalisation for lower respiratory tract infection or all-cause mortality did not differ significantly between penicillin V and amoxicillin (adjusted odds ratio [aOR], 1.07; 95% CI, 0.87-1.32).
• Antibiotic switches were less common after amoxicillin than after penicillin V treatment (aOR, 0.58; 95% CI, 0.50-0.67).

IN PRACTICE:

"Considering the goal of combating antimicrobial resistance, countries with resistance patterns similar to those in Sweden may consider adding narrow-spectrum PcV [penicillin V] as a treatment option for pneumonia in primary care," the authors wrote.

SOURCE:

This study was led by Olof Cronberg, Växjöhälsan Primary Healthcare Centre, Växjö, Sweden. It was published online on August 23, 2025, in Clinical Microbiology and Infection.

LIMITATIONS:

This study lacked data on symptom duration and other clinical indicators, as well as chest radiography and microbiological findings. Information on socioeconomic status was also unavailable, and residual confounding could not be ruled out.

DISCLOSURES:

This study was supported by the Region Kronoberg, Sweden; the Swedish Society of Medicine; the Southern Regional Health Care Committee; and Futurum, Region Jönköping County, Sweden. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.