Community-acquired pneumonia (CAP) is common. How long should we treat with antibiotics? The World Health Organization recommends 3 to 5 days for children with CAP living in low- and middle-income countries (LMICs). The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America recommend 7 to 10 days but note that shorter courses may suffice. What should we do?
Gao et al (10.1542/peds.2022-060097) share with us a systematic review and meta-analysis of randomized clinical trials performed through April 2022 evaluating duration of antibiotic therapy for treatment of CAP. The authors identified 16 trials involving 12,774 patients initially diagnosed in the outpatient setting, although some were subsequently hospitalized. They conclude that with “high certainty” evidence, antibiotic courses ≤5 days are non-inferior to longer duration courses for prevention of mortality. Their meta-analysis also shows with “moderate certainty” that a shorter course of treatment is also non-inferior for clinical cure, relapses, need for changing antibiotics, hospitalization, or severe adverse events.
The authors do identify some limitations of their review strategy in the discussion section of this review article. Even with those limitations, the large sample size of patients included in this review and the use of large recent randomized controlled trial studies emphasize the appropriateness of shorter therapy. Link to this study and learn more.
