Most guidelines recommend five to 10 days of treatment for children who have community-acquired pneumonia, but a shorter course of treatment could improve adherence and reduce adverse effects and costs. A systematic review and meta-analysis was designed to determine whether a shorter course of antibiotics is noninferior to a longer course for the treatment of childhood community-acquired pneumonia.
Nine randomized clinical trials comparing a shorter course with a longer course (for example, three days versus five to 10 days or five days versus seven to 10 days) of the same oral antibiotic in children who had nonsevere community-acquired pneumonia were included in the analysis. Of the 11,143 participants, 58% were male and 98% were two to 59 months of age.
Treatment failure, which was defined by "persistence of pneumonia or the new appearance of any general danger signs of [community-acquired pneumonia], elevated temperature [above 38[degrees]C or 100.4[degrees]F] after completion of treatment, change of antibiotic, hospitalization, death, missing more than three study drug doses, loss to follow-up, or withdrawal of informed consent," occurred in 12.8% of participants randomized to a shorter course of antibiotics compared with 12.6% of participants randomized to a longer course of antibiotics. Overall, a shorter course of antibiotics was noninferior to a longer course with respect to treatment failure. A three-day course was noninferior to a five-day course for the outcome of treatment failure, and a five-day course was noninferior to a 10-day course.
Rates of relapse were similar for short- and long-course therapy in children ages two to 59 months. A shorter course of antibiotics was associated with lower risks of gastroenteritis and rash and with a lower rate of caregiver absenteeism.
One limitation of the study was that it included multiple types of infection, and the optimal duration of therapy may differ for different types of infections. Furthermore, the definitions of pneumonia and treatment failure varied across studies, and there was a lack of data about long-term outcomes.