Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign

  • Ludovico FurlanEmail author
  • Luca Erba
  • Lucia Trombetta
  • Roberto Sacco
  • Giorgio Colombo
  • Giovanni Casazza
  • Monica Solbiati
  • Nicola Montano
  • Chiara Marta
  • Rodolfo Sbrojavacca
  • Francesco Perticone
  • Gino Roberto Corazza
  • Giorgio Costantino


Reduction of the inappropriate use of antibiotics in clinical practice is one of the main goals of the Società Italiana di Medicina Interna (SIMI) choosing wisely campaign. We conducted a systematic review of secondary studies (systematic reviews and guidelines) to verify what evidence is available on the duration of antibiotic treatment in Pneumonia. A literature systematic search was performed to identify all systematic reviews and the three most cited and recent guidelines that address the duration of antibiotic therapy in pneumonia. Moreover, a meta-analysis of non-duplicate data from randomized controlled trials (RCTs) considered in the enrolled systematic reviews was performed together with a trial sequential analysis to identify the need for further studies. Two systematic reviews on antibiotic duration in community-acquired pneumonia (CAP) for a total of 17 RCTs (2764 patients) were enrolled in our study. Meta-analysis of non-duplicate RCTs show a non-significant difference in rate of treatment failure between short (≤ 7 days) and long (> 7 days) antibiotic treatment course: RR 1.05 (95% CI, 0.82–1.36). The trial sequential analysis suggests that further data would not affect current evidence or become clinically relevant. Selected guidelines suggest consideration of a short course, with a low grade of evidence and without citing the already published systematic reviews. Antibiotic treatment of CAP for ≤ 7 days is not associated with a higher rate of treatment failure than longer courses and should thus be taken in consideration. Guidelines should upgrade the evidence on this topic.


Infection Pneumonia Antibiotic treatment Choosing wisely Systematic review Guidelines 



We would like to thank all the members of the SIMI Choosing Wisely Group for their help in the writing of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any study with human participants or animals performed by any of the authors.

Informed Consent

No informed consent was required for the study.


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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  • Ludovico Furlan
    • 1
    Email author
  • Luca Erba
    • 1
  • Lucia Trombetta
    • 1
  • Roberto Sacco
    • 1
  • Giorgio Colombo
    • 1
  • Giovanni Casazza
    • 2
  • Monica Solbiati
    • 3
  • Nicola Montano
    • 4
    • 5
  • Chiara Marta
    • 6
  • Rodolfo Sbrojavacca
    • 7
  • Francesco Perticone
    • 8
  • Gino Roberto Corazza
    • 9
  • Giorgio Costantino
    • 3
    • 4
  1. 1.Università degli Studi di MilanoMilanItaly
  2. 2.Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”Università degli Studi di MilanoMilanItaly
  3. 3.Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d’UrgenzaMilanItaly
  4. 4.Dipartimento di Scienze Cliniche e di ComunitàUniversità degli Studi di MilanoMilanItaly
  5. 5.Dipartimento di Medicina Interna, Ospedale Maggiore PoliclinicoFondazione IRCCS Ca’ GrandaMilanItaly
  6. 6.Dipartimento delle professioni sanitarie, Ospedale Maggiore PoliclinicoFondazione IRCCS Ca’ GrandaMilanItaly
  7. 7.Dipartimento di Pronto Soccorso e Medicina d’UrgenzaAzienda Ospedaliera Universitaria di UdineUdineItaly
  8. 8.Department of Medical and Surgical Sciences“Magna-Græcia” University of CatanzaroCatanzaroItaly
  9. 9.Dipartimento di Medicina InternaIRCCS Fondazione Policlinico San Matteo, Università di PaviaPaviaItaly

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