A review and meta-analysis of randomized clinical trials suggests shorter antibiotic durations are as safe and effective as longer durations in children with community-acquired pneumonia (CAP), researchers reported today in Pediatrics.
To evaluate the evidence on antibiotic treatment durations for children with CAP, a team of Chinese and Canadian researchers reviewed and analyzed 16 randomized controlled trials conducted in high- and low-income countries comparing shorter (5 days or less) with longer antibiotic durations in 12,774 patients. Guidelines from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America recommend 7 to 10 days of antibiotics but acknowledge that shorter courses may be just as effective, while the World Health Organization recommends 3 to 5 days for children in low- and middle-income countries.
The meta-analysis found no substantial differences between shorter-duration and longer-duration antibiotics in clinical cure (odds ratio 1.01; 95% confidence interval [CI], 0.87 to 1.17; risk difference [RD] ,0.1%; moderate certainty), treatment failure (relative risk [RR], 1.06; 95% CI, 0.93 to 1.21; RD, 0.3%; moderate certainty), and relapse (RR, 1.12, 95% CI 0.92 to 1.35; RD, 0.5%; moderate certainty). Compared with longer-duration antibiotics, shorter-duration antibiotics do not appreciably increase mortality (RD, 0.0%; 95% CI, −0.2 to 0.1; high certainty), and probably have little or no impact on the need for change in antibiotics (RR, 1.03; 95% CI, 0.72 to 1.47; RD, 0.2%; moderate certainty), need for hospitalization (RD, −0.2%; 95% CI −0.9 to 0.5; moderate certainty), and severe adverse events (RD, 0.0%; 95% CI −0.2 to 0.2; moderate certainty).
We showed with reasonable certainty that shorter-duration therapy appears to be as efficacious and as safe as longer-duration therapy across a range of settings.
The study authors say the review is the most comprehensive yet to show the efficacy and safety of shorter versus longer antibiotic durations in children with CAP.
"Though it may be that there are differences in the typical phenotype of a child with CAP in different regions, and management guidelines are likely to vary, we showed with reasonable certainty that shorter-duration therapy appears to be as efficacious and as safe as longer-duration therapy across a range of settings," they wrote.