Three Days of Antibiotics May Suffice for Treatment of Nonsevere Pneumonia in Children
April 24, 2008 — A short course (3 days) of antibiotic therapy is equally as effective as a longer treatment (5 days) of nonsevere, community-acquired pneumonia in children, according to the results of a review published in the April 16 Cochrane Database of Systematic Reviews.
"Treatment of pneumonia requires an effective antibiotic used in adequate doses for an appropriate duration," write Batool A. Haider, from the Aga Khan University in Karachi, Pakistan, and colleagues. "Recommended duration of treatment ranges between 7 and 14 days, but this is not based on any empirical evidence. Shorter duration of therapy, if found to be effective, could be particularly important in resource-poor settings where there is a high risk of death, poor access to medicines and health care, and limited budgets for medicines."
The goal of this review was to compare the efficacy of a short vs a long course of treatment with the same antibiotic for nonsevere, community-acquired pneumonia in children 2 to 59 months of age.
The reviewers searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (The Cochrane Library, 2007, Issue 3), MEDLINE (OVID; January 1966 to September 2007), EMBASE (Embase.com; 1974 to September 2007), and LILACS (1982 to September 2007), looking for all randomized controlled trials (RCTs) comparing the efficacy of a short vs a long course of treatment of the same antibiotic for nonsevere, community-acquired pneumonia in children. Two reviewers independently evaluated the quality of the studies and extracted data.
There were 3 studies identified meeting inclusion criteria; these enrolled a total of 5763 children with nonsevere pneumonia. Comparing 3 days vs 5 days of treatment with the same antibiotic showed no significant differences in the rates of clinical cure at the end of treatment (relative risk [RR], 0.99; 95% confidence interval [CI], 0.97 - 1.01), treatment failure at the end of treatment (RR, 1.07; 95% CI, 0.92 - 1.25), and relapse after 7 days of clinical cure (RR, 1.09; 95% CI, 0.83 - 1.42).
There were no significant differences for these outcomes with different durations of therapy with different antibiotics, based on subgroup analysis. When data were categorized based on antibiotics used, which included amoxicillin and cotrimoxazole, the differences remained nonsignificant.
Limitations of this review include small number of studies available, lack of data on other secondary outcomes (eg, mortality rate at 1 month and additional interventions), and use of a simplified definition of pneumonia according to the World Health Organization (WHO).
"The evidence of this review suggests that a short course (three days) of antibiotic therapy is as effective as a longer treatment (five days) for non-severe pneumonia in children under five years of age," the review authors write. "However, there is a need for more well-designed RCTs to support our review findings."
Cochrane Database Syst Rev. Published online April 16, 2008.
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