Background: 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.
Methods: We systematically searched PubMed, EMBASE, 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" and treatment for ≥7 days as "long-course".
Results: Twenty-one clinical trials (4861 clinically evaluable patients) were included and 19 out of 21 trials were randomized. Clinical cure was similar between the compared groups [4069 patients, RR= 0.99 (95% CI, 0.97-1.01)], irrespective of patient setting (outpatient/inpatient) [RR= 0.98, (95% CI, 0.96-1.00)/RR= 1.00, (95% CI, 0.92-1.09), respectively] or severity of pneumonia [RR= 1.05, (95% CI, 0.96-1.14)]. Also, relapses were similar between short and long-course treatment groups [1923 patients, RR= 0.67 (95% CI, 0.30-1.46)]. Short-course treatment was associated with fewer serious adverse events [1923 patients, RR= 0.73 (95% CI, 0.55-0.97)] and, importantly, resulted in lower mortality compared to long-course treatment [2802 patients, RR= 0.52 (95% CI, 0.33-0.82)].
Conclusion: In CAP, short-course antibiotic treatment (≤6 days) is equally effective and potentially superior, in terms of mortality and serious adverse events, compared to longer-course treatment.
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