Efficacy and safety of short-course antibiotic therapy for community-acquired pneumonia in adults: a meta-analysis
Abstract
Background: Optimizing antibiotic duration for community-acquired pneumonia (CAP) is a critical priority for global antimicrobial stewardship. While short-course therapies (≤5 days) show clinical promise, robust, updated evidence comparing their specific safety profiles, particularly regarding severe adverse events, against traditional long-course regimens (>5 days) is required to reliably guide clinical practice.
Methods: Following the PRISMA 2020 guidelines (PROSPERO: CRD420261278947), we systematically searched PubMed, Embase, and CENTRAL up to January 15, 2026, for randomized controlled trials (RCTs) comparing short-course (≤5 days) and long-course (>5 days) antibiotic therapies in adults with CAP. The primary outcome was clinical success. Secondary outcomes included bacteriological and radiological success, mortality, treatment discontinuation, and a detailed profile of adverse events (AEs).
Results: A total of 21 RCTs were included. Short-course antibiotic therapy achieved comparable efficacy to long-course therapy in clinical success (RR = 1.00, 95% CI: 0.98-1.02, p = 0.77), bacteriological success (RR = 1.00, 95% CI: 0.97-1.03, p = 0.86), radiological success (RR = 1.03, 95% CI: 0.97-1.09, p = 0.29), all-cause mortality (RR = 0.79, 95% CI: 0.47-1.32, p = 0.37), and treatment discontinuation (RR = 0.95, 95% CI: 0.68-1.31, p = 0.74). While short-course regimens were associated with a marginally higher risk of mild treatment-related AEs (RR = 1.12, 95% CI: 1.00-1.26, p…
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