Written by Kimiko Dunbar
Spoon Feed
Short course of antibiotic therapy (≤6 days) is just as effective in treatment of uncomplicated pediatric community-acquired pneumonia as long-course (>7 days) therapy.
Does my kid really need a week of antibiotics?
The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America have recommended 10 day treatment courses for pediatric community acquired pneumonia (CAP), though shorter courses are increasingly being studied and implemented in practice.
This systematic review and meta-analysis evaluated the efficacy of short-course (≤6 days) versus long-course (>7 days) antibiotic therapy for pediatric CAP. Seventeen studies including 155,944 patients ≤18 years old showed no significant differences in clinical cure (RR 1.01, 95% CI 0.97–1.05) or treatment failure (RR 0.88, 95% CI 0.51–1.51). Short-course treatment was associated with fewer serious adverse events (RR 0.89, 95% CI 0.79–0.99).
While a large study, the population of studies was quite heterogeneous. “Short-course” antibiotics were variable, including amoxicillin in some studies, single dose azithromycin in others, and unspecified antibiotics in two. Further, definitions of clinical cure, treatment failure, and adverse events were also not universal across studies. Overall, however, the findings do support shorter courses of antibiotics for CAP and the implementation of antimicrobial stewardship programs in order to reduce antimicrobial resistance.
How will this change my practice?
The findings in this study align with the guidelines at my current institution, supporting a shorter antibiotic course for treatment of uncomplicated community acquired pneumonia. I’m a firm believer in treating with just 5 days, so I was excited that this study aligns with that. That said, it’s important to note the study settings. 10 were conducted in the outpatient setting, 1 in an inpatient setting and 2 in both (4 did not specify setting). Perhaps greater thought should be given to those presenting with a more severe case of CAP requiring inpatient hospitalization. However, for most kids, inpatient or not, a shorter course is probably enough.
Source
Evaluating Short-Course Antibiotic Therapy for Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis. Pediatr Infect Dis J. 2025 Feb 3. doi: 10.1097/INF.0000000000004749. Epub ahead of print. PMID: 39898624
