Shorter Versus Longer-term Antibiotic Treatments for Community-Acquired Pneumonia in Children: A Meta-analysis

Abstract

Context: The optimal duration of antibiotic treatment of children with community-acquired pneumonia (CAP) remains unclear.

Objectives: This study aimed to compare the efficacy and safety of shorter versus longer duration of antibiotic treatment of children with CAP.

Data sources: We searched Medline, Embase, CENTRAL, and CINAHL.

Study selection: Randomized clinical trials comparing shorter (≤5 days) with longer duration antibiotic treatments in children with CAP.

Data extraction: Paired reviewers independently extracted data and we performed random-effects meta-analyses to summarize the evidence.

Results: Sixteen trials with 12 774 patients, treated as outpatients with oral antibiotics, proved eligible. There are probably 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).

Limitations: For some outcomes, evidence was lacking.

Conclusions: Duration of antibiotic therapy likely makes no important difference in patient-important outcomes. Healthcare workers should prioritize the use of shorter-duration antibiotics for children with CAP treated as outpatients with oral antibiotics.