Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis.
Options
BORIS DOI
Publisher DOI
PubMed ID
36948555
Description
OBJECTIVES
To find the optimal treatment duration with antibiotics for community-acquired pneumonia (CAP) in adults.
DESIGN
Systematic review and duration-effect meta-analysis.
DATA SOURCES
MEDLINE, Embase and CENTRAL through 25 August 2021.
ELIGIBILITY CRITERIA
All randomised controlled trials comparing the same antibiotics used at the same daily dosage but for different durations for CAP in adults. Both outpatients and inpatients were included but not those admitted to intensive care units. We imposed no date, language or publication status restriction.
DATA EXTRACTION AND SYNTHESIS
Data extraction by two independent reviewers. We conducted a random-effects, one-stage duration-effect meta-analysis with restricted cubic splines. We tested the non-inferiority with the prespecified non-inferiority margin of 10% examined against 10 days . The primary outcome was clinical improvement on day 15 (range 7-45 days).
SECONDARY OUTCOMES
all-cause mortality, serious adverse events and clinical improvement on day 30 (15-60 days).
RESULTS
We included nine trials (2399 patients with a mean (SD) age of 61.2 (22.1); 39% women). The duration-effect curve was monotonic with longer duration leading to a lower probability of improvement, and shorter treatment duration (3-9 days) was likely to be non-inferior to 10-day treatment. Harmful outcome curves indicated no association. The weighted average percentage of the primary outcome in the 10-day treatment arms was 68%. Using that average, the absolute clinical improvement rates of the following durations were: 3-day treatment 75% (95% CI: 68% to 81%), 5-day treatment 72% (95% CI: 66% to 78%) and 7-day treatment 69% (95% CI: 61% to 76%).
CONCLUSIONS
Shorter treatment duration (3-5 days) probably offers the optimal balance between efficacy and treatment burden for treating CAP in adults if they achieved clinical stability. However, the small number of included studies and the overall moderate-to-high risk of bias may compromise the certainty of the results. Further research on the shorter duration range is required.
PROSPERO REGISTRATION NUMBER
CRD 42021273357.
To find the optimal treatment duration with antibiotics for community-acquired pneumonia (CAP) in adults.
DESIGN
Systematic review and duration-effect meta-analysis.
DATA SOURCES
MEDLINE, Embase and CENTRAL through 25 August 2021.
ELIGIBILITY CRITERIA
All randomised controlled trials comparing the same antibiotics used at the same daily dosage but for different durations for CAP in adults. Both outpatients and inpatients were included but not those admitted to intensive care units. We imposed no date, language or publication status restriction.
DATA EXTRACTION AND SYNTHESIS
Data extraction by two independent reviewers. We conducted a random-effects, one-stage duration-effect meta-analysis with restricted cubic splines. We tested the non-inferiority with the prespecified non-inferiority margin of 10% examined against 10 days . The primary outcome was clinical improvement on day 15 (range 7-45 days).
SECONDARY OUTCOMES
all-cause mortality, serious adverse events and clinical improvement on day 30 (15-60 days).
RESULTS
We included nine trials (2399 patients with a mean (SD) age of 61.2 (22.1); 39% women). The duration-effect curve was monotonic with longer duration leading to a lower probability of improvement, and shorter treatment duration (3-9 days) was likely to be non-inferior to 10-day treatment. Harmful outcome curves indicated no association. The weighted average percentage of the primary outcome in the 10-day treatment arms was 68%. Using that average, the absolute clinical improvement rates of the following durations were: 3-day treatment 75% (95% CI: 68% to 81%), 5-day treatment 72% (95% CI: 66% to 78%) and 7-day treatment 69% (95% CI: 61% to 76%).
CONCLUSIONS
Shorter treatment duration (3-5 days) probably offers the optimal balance between efficacy and treatment burden for treating CAP in adults if they achieved clinical stability. However, the small number of included studies and the overall moderate-to-high risk of bias may compromise the certainty of the results. Further research on the shorter duration range is required.
PROSPERO REGISTRATION NUMBER
CRD 42021273357.
Date of Publication
2023-03-22
Publication Type
Article
Subject(s)
600 - Technology::610 - Medicine & health
300 - Social sciences, sociology & anthropology::360 - Social problems & social services
Keyword(s)
bacteriology respiratory infections respiratory medicine (see thoracic medicine)
Language(s)
en
Contributor(s)
Furukawa, Yuki | |
Luo, Yan | |
Funada, Satoshi | |
Onishi, Akira | |
Ostinelli, Edoardo | |
Furukawa, Toshi A | |
Kataoka, Yuki |
Additional Credits
Institut für Sozial- und Präventivmedizin (ISPM) - Evidence Synthesis Methods
Series
BMJ open
Publisher
BMJ Publishing Group
ISSN
2044-6055
Access(Rights)
open.access