Short- versus long-course antibiotic therapy in non-severe CAP in children: a systematic review and meta-analysis.
Achilleas Klapas, Panagiotis Panagopoulos, Alexandros Makis et al.
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In 30 seconds
This systematic review and meta-analysis compared short-course (≤ 5 days) with longer (> 5 days) antibiotic therapy for non-severe community-acquired pneumonia in immunocompetent children. Ten randomized clinical trials involving 8970 children were included. Treatment failure and relapse did not differ significantly between durations. Shorter courses were associated with less non-adherence to the active study drug (RR = 0.35 (95% CI, 0.24-0.50)). The authors note that the analysis was not designed to establish non-inferiority or equivalence.
Key findings
- Treatment failure did not differ significantly between short and longer courses [RR = 1.07 (95% CI, 0.93-1.24), I 2 = 3%].
- Relapse rates did not differ significantly [RR = 1.04 (95% CI, 0.72-1.49), I 2 = 0%].
- Shorter regimens were associated with lower non-adherence [RR = 0.35 (95% CI, 0.24-0.50), I 2 = 54%].
- Antibiotic-related adverse events were comparable [RR = 0.71 (95% CI, 0.36-1.40), I 2 = 81%].
Why it matters
Antibiotic duration affects treatment burden, and completing therapy can be challenging for children. The lower non-adherence associated with shorter courses is a practical advantage alongside the absence of significant differences in treatment failure or relapse. These findings inform consideration of duration while not proving that short courses are equivalent or non-inferior.
What to keep in mind
The meta-analysis was not designed to formally establish non-inferiority or equivalence; adverse-event estimates showed substantial heterogeneity (I 2 = 81%).