Article

Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis.

Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, CA 94143-0862, USA.
The American journal of medicine (impact factor: 4.47). 10/2007; 120(9):783-90. DOI:10.1016/j.amjmed.2007.04.023 pp.783-90
Source: PubMed

ABSTRACT 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.
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.
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).
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.

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Keywords

15 randomized
 
2796 total subjects
 
3 studies utilized
 
7 days
 
95% confidence interval [CI]
 
antibiotic regimen
 
antibiotic treatment
 
antimicrobial drug resistance
 
available studies
 
community-acquired pneumonia
 
compared short-course
 
extended-course antibiotic regimens
 
extended-course regimens
 
favorable clinical efficacy
 
moderate community-acquired pneumonia
 
primary outcome measure
 
reference lists
 
relative risk
 
Short-course regimens
 
systematically review randomized
 

Jonathan Z Li