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.
Keywords
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© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
