Clinical research study
Efficacy of Short-Course Antibiotic Regimens for Community-Acquired Pneumonia: A Meta-analysis

The data in this article were presented in part at the 46th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA, September 27-30, 2006 (Session 162, Paper L-1458).
https://doi.org/10.1016/j.amjmed.2007.04.023Get rights and content

Abstract

Purpose

There is little consensus on the most appropriate duration of antibiotic treatment for community-acquired pneumonia. The goal of this study is to systematically review randomized controlled trials comparing short-course and extended-course antibiotic regimens for community-acquired pneumonia.

Methods

We searched MEDLINE, Embase, and CENTRAL, and reviewed reference lists from 1980 through June 2006. Studies were included if they were randomized controlled trials that compared short-course (7 days or less) versus extended-course (>7 days) antibiotic monotherapy for community-acquired pneumonia in adults. The primary outcome measure was failure to achieve clinical improvement.

Results

We found 15 randomized controlled trials matching our inclusion and exclusion criteria comprising 2796 total subjects. Short-course regimens primarily studied the use of azithromycin (n = 10), but trials examining beta-lactams (n = 2), fluoroquinolones (n = 2), and ketolides (n = 1) were found as well. Of the extended-course regimens, 3 studies utilized the same antibiotic, whereas 9 involved an antibiotic of the same class. Overall, there was no difference in the risk of clinical failure between the short-course and extended-course regimens (0.89, 95% confidence interval [CI], 0.78-1.02). In addition, there were no differences in the risk of mortality (0.81, 95% CI, 0.46-1.43) or bacteriologic eradication (1.11, 95% CI, 0.76-1.62). In subgroup analyses, there was a trend toward favorable clinical efficacy for the short-course regimens in all antibiotic classes (range of relative risk, 0.88-0.94).

Conclusions

The available studies suggest that adults with mild to moderate community-acquired pneumonia can be safely and effectively treated with an antibiotic regimen of 7 days or less. Reduction in patient exposure to antibiotics may limit the increasing rates of antimicrobial drug resistance, decrease cost, and improve patient adherence and tolerability.

Section snippets

Search Strategy

We used the Cochrane Central Register of Controlled Trials, Medline, and Embase to find publications from 1980 through June 2006. In the Cochrane database, the record title was searched for the keyword “pneumonia.” Articles in Medline and Embase were found by searching for clinical studies or trials with the word “pneumonia” in the title and without the following keywords in the title: “pneumocystis,” “aspiration,” “aspirate,” “nosocomial,” “ventilator,” “ventilation,” “ventilated,”

Description of Studies

Our search strategy identified more than 3700 potential references (Figure 1). Most studies were excluded due to the fact that they were not randomized controlled trials or did not compare a short-course versus an extended-course antibiotic regimen. Fifteen studies met our inclusion and exclusion criteria and were included in this meta-analysis (Table 1). These studies were published between 1990 and 2004 and comprised a total of 2796 subjects. Ten studies enrolled more than 100 participants

Discussion

In this meta-analysis, we found no significant differences between short-course and extended-course antibiotic regimens for the treatment of mild to moderate community-acquired pneumonia with respect to clinical success, mortality, bacteriologic success, and adverse events. The results were consistent across a wide range of analyses, including both the intention-to-treat and per-protocol patient populations, high-quality studies, and individual antibiotic classes. Both outpatients and

Acknowledgments

We thank Gloria Won for her invaluable advice on the Embase and Medline literature searches. We are grateful for the help Yoshio Hall and Delphine Tuot provided in translating articles.

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