Shorter Courses of Antibiotics Noninferior to Longer Courses in Children

A recent study published in the JAMA Pediatrics suggests that short-course antibiotic therapy could enhance adherence and reduce adverse drug effects and costs. However, based on sparse evidence, most guidelines recommend a longer course of antibiotics for nonsevere childhood community-acquired pneumonia (CAP).

A study was conducted to determine whether a shorter course of antibiotics was noninferior to a longer course for childhood nonsevere CAP.

Random-effects models were used to pool the data, which were analyzed from April 15, 2022, to May 15, 2022. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.

Treatment failure was defined by:

• Persistence of pneumonia or the new appearance of any general danger signs of CAP (e.g., lethargy, unconsciousness, seizures, or inability to drink)
• Elevated temperature (>38 °C) after completion of treatment
• Change of antibiotic
• Hospitalization
• Death
• Missing more than 3 study drug doses
• Loss to follow-up
• Withdrawal of informed consent

Results

Nine randomized clinical trials including 11,143 participants were included in this meta-analysis. A total of 98% of the participants were aged 2 to 59 months, and 58% were male. Eight studies with 10,662 patients reported treatment failure.

Treatment failure occurred in 12.8% vs 12.6% of participants randomized to a shorter vs a longer course of antibiotics.

High-quality evidence showed that a shorter course of oral antibiotic was noninferior to a longer course with respect to treatment failure for children with nonsevere CAP.

A 3-day course of antibiotic treatment was noninferior to a 5-day course for the outcome of treatment failure, and a 5-day course was noninferior to a 10-day course.

A shorter course of antibiotics was associated with fewer reports of gastroenteritis and lower caregiver absenteeism.

Results of this meta-analysis suggest that a shorter course of antibiotics was noninferior to a longer course in children aged 2 to 59 months with nonsevere CAP. Clinicians should consider prescribing a shorter course of antibiotics for the management of pediatric nonsevere CAP.

Reference

Li Q, Zhou Q, Florez ID, et al. Short-Course vs Long-Course Antibiotic Therapy for Children With Nonsevere Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. JAMA Pediatr. Published online November 14, 2022. doi:10.1001/jamapediatrics.2022.4123

Keywords

Shorter courses, antibiotics, noninferior, longer courses, children, JAMA Pediatrics, Qinyuan Li, Qi Zhou, Ivan D. Florez