Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign
- 193 Downloads
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.
KeywordsInfection 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.
No informed consent was required for the study.
- 2.World Health Organization (2015) Global action plan on antimicrobial resistance. WHO Press, Geneva, pp 1–28Google Scholar
- 8.Altman D (1991) Practical statistics for medical research. Chapman and Hall, Boca RatonGoogle Scholar
- 11.Leophonte P, Choutet P, Gaillat J et al (2002) Efficacy of a ten day course of ceftriaxone compared to shortened five day course in the treatment of community-acquired pneumonia in hospitalised adults with risk factors. Med Mal, Infect, p 32Google Scholar
- 12.Tellier G, Niederman MS, Nusrat R et al (2004) Clinical and bacteriological efficacy and safety of 5 and 7 day regimens of telithromycin once daily compared with a 10 day regimen of clarithromycin twice daily in patients with mild to moderate community-acquired pneumonia. J Antimicrob Chemother 54:515–523CrossRefGoogle Scholar
- 18.Kobayashi H (1995) Clarithromycin-controlled randomized double-Blind studies of azithromycin for treatment of pneumonia. Jpn J Chemother 43:757–774Google Scholar
- 56.Rotstein C, Evans G, Born A et al (2008) Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol = J Can des Mal Infect la Microbiol médicale/AMMI Canada 19:19–53Google Scholar
- 67.Pugh R, Grant C, Cooke RP et al (2015) Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev 8:CD007577Google Scholar
- 71.Medina JC, Perez Protto SE, Paciel D et al (2007) Antibiotic treatment for the ventilator-associated pneumonia: 8 vs.12 days randomized trial preliminary data. Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, 2007Google Scholar