Clinical Health Updates

Pneumonia can be treated with 3 to 5 days of antibiotics

Clinical Question:
Can community-acquired pneumonia be treated with 3 days to 5 days of antibiotic therapy?

Bottom Line:
Ten to 14 days of antibiotics are no more effective in patients with community-acquired pneumonia than 3 to 5 days of treatment. Clinical failures and mortality were similar regardless of treatment length. The equivalent effectiveness was demonstrated with 3 to 5 days of oral or parenteral azithromycin, levofloxacin for 5 days, cefuroxime for 7 days, and intravenous ceftriaxone for 5 days.

Reference:
Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med 2007;120(9):783-790.

Study Design:
Meta-analysis (randomized controlled trials)

Synopsis:
There is little consensus on the most appropriate duration of antibiotic treatment for community-acquired pneumonia. The authors systematically reviewed randomized controlled trials comparing short-course and extended-course antibiotic regimens for community-acquired pneumonia. They searched MEDLINE, Embase, and CENTRAL, and reviewed reference lists from 1980 through June 2006. Studies were included if they were randomized controlled trials that compared short-course (7 days or less) versus extended-course (>7 days) antibiotic monotherapy for community-acquired pneumonia in adults. The primary outcome measure was failure to achieve clinical improvement. They found 15 randomized controlled trials matching our inclusion and exclusion criteria comprising 2796 total subjects. Short-course regimens primarily studied the use of azithromycin (n=10), but trials examining beta-lactams (n=2), fluoroquinolones (n=2), and ketolides (n=1) were found as well. Of the extended-course regimens, 3 studies utilized the same antibiotic, whereas 9 involved an antibiotic of the same class. Overall, there was no difference in the risk of clinical failure between the short-course and extended-course regimens (0.89, 95% confidence interval [CI], 0.78-1.02). In addition, there were no differences in the risk of mortality (0.81, 95% CI, 0.46-1.43) or bacteriologic eradication (1.11, 95% CI, 0.76-1.62). In subgroup analyses, there was a trend toward favorable clinical efficacy for the short-course regimens in all antibiotic classes (range of relative risk, 0.88-0.94).