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Length of Antibiotic Courses in Pediatric Nonsevere Community-Acquired Pneumonia

Short courses of antibiotic therapy are noninferior to longer regimens in infants and young children aged 2 to 59 months with nonsevere community-acquired pneumonia (CAP), a meta-analysis shows. “Clinicians should consider prescribing a shorter course of antibiotics for the management of pediatric nonsevere CAP,” the authors conclude.

A systematic review identified 9 randomized clinical trials with 11,143 participants for inclusion in the meta-analysis. Most patients were male, and 98% were in the 2- to 59-month age range. “Treatment failure occurred in 12.8% vs 12.6% of participants randomized to a shorter vs a longer course of antibiotics,” the authors report. “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 (risk ratio, 1.01; 95% CI, 0.92-1.11; risk difference, 0.00; 95% CI, –0.01 to 0.01; I2 = 0%). A 3-day course of antibiotic treatment was noninferior to a 5-day course for the outcome of treatment failure (risk ratio, 1.01; 95% CI, 0.91-1.12; I2 = 0%), and a 5-day course was noninferior to a 10-day course (risk ratio, 0.87; 95% CI, 0.50-1.53; I2 = 0%). A shorter course of antibiotics was associated with fewer reports of gastroenteritis (risk ratio, 0.79; 95% CI, 0.66-0.95) and lower caregiver absenteeism (incident rate ratio, 0.74; 95% CI, 0.65-0.84).”

Source: JAMA Pediatrics