Lancet Infect Dis

Shorter antibiotic courses sufficient for some respiratory infections, review finds

September 30, 2024

Evidence supports a 5-day antibiotic course for non-ICU community-acquired pneumonia (CAP) and acute exacerbation of COPD (AECOPD) in patients who've clinically improved, but further high-quality research is necessary to determine optimal durations for other respiratory infections like hospital-acquired pneumonia (HAP) and acute sinusitis.

• This umbrella review assessed the evidence base for shortening antibiotic duration in various respiratory tract infections. A total of 30 systematic reviews that address treatment durations in CAP, AECOPD, HAP, acute sinusitis, and streptococcal pharyngitis, tonsillitis, or pharyngotonsillitis were included.
• Fourteen reviews (8 of which were meta-analyses) yielded moderate-quality evidence that 5 days of antibiotics is clinically non-inferior to a longer course for non-ICU CAP, but the evidence was insufficient to support anything shorter than 5 days.
• For AECOPD, 8 reviews (5 of which were meta-analyses) found sufficient evidence supporting a treatment duration of 5 days, but evidence for shorter durations was scarce.
• Evidence for shorter durations for non-ventilator-associated HAP and acute sinusitis is lacking.
• There is sufficient evidence to support short-course cephalosporin but not short-course penicillin when dosed three times a day for pharyngotonsillitis (8 reviews, of which 6 were meta-analyses).

Source:

Kuijpers SME, et al. (2024, September 4). Lancet Infect Dis. The evidence base for the optimal antibiotic treatment duration of upper and lower respiratory tract infections: an umbrella review. https://pubmed.ncbi.nlm.nih.gov/39243792/