Systematic Review and Meta-analysis of the Efficacy of Short-Course Antibiotic Treatments for Community-Acquired Pneumonia in Adults

Abstract

The duration of therapy for community-acquired pneumonia (CAP) remains undefined. We sought to investigate whether short-course antibiotic treatment for CAP is associated with favorable clinical outcomes in adult patients. We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for studies comparing the effectiveness and safety between treatment regimens administered for ≤6 days and ≥7 days. We defined treatment for ≤6 days as short-course treatment and treatment for ≥7 days as long-course treatment. Twenty-one clinical trials (4,861 clinically evaluable patients) were included, and 19 out of 21 trials were randomized. Clinical cure was similar between the compared groups (4,069 patients, risk ratio [RR] = 0.99 [95% confidence interval {CI}, 0.97 to 1.01]), irrespective of patient setting (RR = 0.98 [95% CI, 0.96 to 1.00] for the outpatient setting and RR = 1.00 [95% CI, 0.92 to 1.09] for the inpatient setting) or severity of pneumonia (RR = 1.05 [95% CI, 0.96 to 1.14]). Also, relapses were similar between the short- and long-course treatment groups (1,923 patients, RR = 0.67 [95% CI, 0.30 to 1.46]). Short-course treatment was associated with fewer serious adverse events (1,923 patients, RR = 0.73 [95% CI, 0.55 to 0.97]) and, importantly, resulted in lower mortality than long-course treatment (2,802 patients, RR = 0.52 [95% CI, 0.33 to 0.82]). In CAP, short-course antibiotic treatment (≤6 days) is as effective as and potentially superior to, in terms of mortality and serious adverse events, longer-course treatment.

Keywords: Chlamydia pneumoniae; Haemophilus influenzae; Mycoplasma pneumoniae; Streptococcus pneumoniae; extended; influenza; mortality; pneumonia; prolonged; short term.

FIG 1

Flow diagram of the study selection process.

FIG 2

Forest plot depicting the risk ratios of clinical cure for clinically evaluable patients receiving antibiotic treatment for ≤6 days versus ≥7 days in clinical trials, stratified by type of regimen. The vertical line indicates the no-difference point between the two regimens; horizontal lines indicate the 95% confidence intervals (CI). ■, risk ratios; ◆, pooled risk ratios for all studies; M-H, Mantel-Haenszel fixed-effect model; df, degrees of freedom.

FIG 3

Forest plot depicting the risk ratios of mortality for patients receiving antibiotic treatment for ≤6 days versus ≥7 days in clinical trials, stratified by duration of therapy. The vertical line indicates the no-difference point between the two regimens; horizontal lines indicate the 95% confidence intervals (CI). ■, risk ratios; ◆, pooled risk ratios for all studies.

FIG 4

Forest plot depicting the risk ratios of serious adverse events for patients receiving antibiotic treatment for ≤6 days versus ≥7 days in clinical trials, stratified by duration of therapy. The vertical line indicates the no-difference point between the two regimens; horizontal lines indicate the 95% confidence intervals (CI). ■, risk ratios; ◆, pooled risk ratios for all studies.

FIG 5

Forest plot depicting the risk ratios of antibiotic-related adverse events for patients receiving antibiotic treatment for ≤6 days versus ≥7 days in clinical trials, stratified by duration of therapy. The vertical line indicates the no-difference point between the two regimens; horizontal lines indicate the 95% confidence intervals (CI). ■, risk ratios; ◆, pooled risk ratios for all studies.

FIG 6

Forest plot depicting the risk ratios of relapses for patients receiving antibiotic treatment for ≤6 days versus ≥7 days in clinical trials, stratified by duration of therapy. The vertical line indicates the no-difference point between the two regimens; horizontal lines indicate the 95% confidence intervals (CI). ■, risk ratios; ◆, pooled risk ratios for all studies.