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Shortening the Duration of Antibiotic Therapy for Pediatric Bacterial Meningitis

“Rigorous, prospective clinical trial data” are needed “to determine the optimal parenteral antibiotic duration in bacterial meningitis in young infants,” conclude the authors of a systematic review. “Given the associated costs and risks, there is a pressing need for high-quality comparative effectiveness research to further study this question.”

Outcomes of 1 randomized controlled trial, 25 cohort studies, and 6 case series provide these insights into meningitis care: “The randomized controlled trial found no difference in treatment failure rates between 10 and 14 days of therapy. One cohort study concluded that antibiotic courses >21 days were not associated with improved outcomes as compared with shorter courses. The remaining studies had small sample sizes and/or did not stratify outcomes by therapy duration. Meta-analysis was not possible because of the heterogeneity of the treatments and reported outcomes.”

The lack of quality studies must be addressed, adds a Commentary author. Two studies showed that longer antibiotic courses were not linked to better outcomes, but “both studies were very problematic in that the majority of the patients did not have culture-proven bacterial meningitis,” the author writes. He quotes the study authors in reinforcing the “pressing need for comparative effectiveness research to establish the shortest safe duration of antibiotic therapy in this population.”

Source: Pediatrics