Short-course versus standard- or longer-course oral antibiotic therapy for pneumonia and lower respiratory tract infection in children: a systematic review and meta-analysis of randomized controlled trials
Abstract
Reducing unnecessary antibiotic exposure is a major priority in pediatric antimicrobial stewardship. The comparative effectiveness of short-course versus standard- or longer-course oral antibiotic therapy for uncomplicated bacterial infections in children remains uncertain.
To evaluate whether short-course oral antibiotic therapy increases clinical treatment failure compared with standard- or longer-course therapy in children with uncomplicated bacterial infections, with a primary focus on same-antibiotic pediatric pneumonia/lower respiratory tract infection (LRTI) trials.
We conducted a systematic review and meta-analysis of randomized controlled trials. MEDLINE/PubMed, Embase, Web of Science, and CENTRAL were searched, supplemented by citation searching and trial registry review. Eligible studies enrolled children aged 0–18 years with uncomplicated bacterial infections treated with oral antibiotics in outpatient or ambulatory settings. The primary outcome was clinical treatment failure; broader pneumonia/LRTI and all-infection analyses were treated as sensitivity or exploratory analyses. Random-effects meta-analysis used risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs). Risk of bias was assessed with the Cochrane risk-of-bias tool. The review was registered in PROSPERO (CRD420261339263).
Fourteen randomized trials were included; nine same-antibiotic pneumonia/LRTI comparisons contributed to the primary pooled analysis. Short-course therapy…
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