Pediatric Community Acquired Pneumonia: Duration of Outpatient Antibiotics

In children over 6 months of age with community-acquired pneumonia (CAP), outpatient antibiotic treatment lasting 3 to 5 days is as efficacious as the current recommended treatment of 7 to 10 days, according to systematic review and meta-analysis findings published recently in Clinical Infectious Diseases.

As many as 1.5% of children develop CAP in high-income countries; however, the best antibiotic treatment interval remains contentious. Investigators for the current study hypothesized that shorter duration of treatment, if equally effective, could reduce the risk for antibiotic resistance and adverse treatment-related events, such as diarrhea.

The researchers therefore conducted a systematic review and meta-analysis comparing CAP outcomes of short antibiotic treatment vs longer treatment in children older than 6 months. Through a review of Scopus, PubMed, and Web of Science databases, the researchers identified 4 randomized controlled trials concerning the length of antibiotic treatment among children with CAP from 2003 to 2022 and published in English. The primary outcome was the need for hospitalization or re-treatment within 1 month. The development of antibiotic-related adverse events was the secondary outcome.  

The 4 double-blind studies analyzed included 1541 children (mean ages between 28 and 36.8 months). Of those, 784 were treated with short-course antibiotics and 789 with the long-course. Differences between these studies included: (1) the use of 3 different definitions of pneumonia; and (2) treatment of patients with amoxicillin only in 3 studies vs amoxicillin only and amoxicillin plus clavulanate or cefdinir in the fourth study. Notably, the meta-analysis included only outpatients and excluded all patients with suspected complicated pneumonia.

In assessing treatment failures, the investigators found the risk differences (RD) between the cohorts were 0.1% (95% CI, -3.0% to 2.0%), with what researchers describe as high quality of evidence. Retreatment was required in 8.3% of patients in the short course and 7.7% of patients in the long course (RD 0.0; 95% CI, -0.03 to 0.03; I²=0.0%), with researchers ranking the quality of evidence as high. There were no hospitalizations in either group. Risk bias was low in 3 of the 4 studies. The 2 studies that assessed antibiotic-related adverse events found RD was 0.0% (CI 95%, -5.0 to 5.0%) with what researchers described as moderate quality of evidence.

Researchers concluded that, “A short antibiotic treatment duration of 3–5 days was equally effective and safe compared to the longer (current) recommendation of 7–10 days in children aged over 6 months with CAP.” Based on these findings, study authors recommended utilizing short-course antibiotics for pediatric CAP.

Analysis limitations include the use of differing CAP definitions in the 4 studies analyzed, the requirement of patient chest radiography in only 2 studies, and the fact that half of patients analyzed came from 1 study.

Reference

Kuitunen I, Jääskeläinen J, Korppi M, Renko M. Antibiotic treatment duration for community acquired pneumonia in outpatient children in high-income countries – a systematic review and meta-analysis. Clin Infect Dis. Published online May 17, 2022. doi:10.1093/cid/ciac374