Shorter Versus Longer Duration of Amoxicillin-based Treatment for Pediatric Patients with Community-acquired Pneumonia: a Systematic Review and Meta-analysis

Overview

Journal Eur J Pediatr

Specialty Pediatrics

Date 2022 Sep 6

PMID 36066660

Authors

Isabela R Marques

Izabela P Calvi

Sara A Cruz

Luana M F Sanchez

Isis F Baroni

Christi Oommen

Eduardo M H Padrao

Paula C Mari

Affiliations

Soon will be listed here.

Abstract

Conclusion: These findings suggest that a short course of Amoxicillin (5 days) is just as effective as a longer course (10 days) for uncomplicated CAP in children under 10 years old. Nevertheless, generalizations should be made with caution considering the socioeconomic settings of the studies included.PROSPERO Identifier: CRD42022328519.

What Is Known: • In the outpatient setting, a few international guidelines recommend a 10-day Amoxicillin course as first-line treatment for community-acquired pneumonia (CAP). • Recent trials have shown that shorter courses of Amoxicillin may be as effective as 10-day regimens in uncomplicated pneumonia.

What Is New: • When comparing 5-day to 10-day Amoxicillin regimens, evidence suggests no significant difference in clinical cure rates for uncomplicated CAP in outpatient settings. • Generalizations should be made with caution considering the socioeconomic context of the population within the included studies.

Citing Articles

Treatment of mild to moderate community-acquired pneumonia in previously healthy children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-FIMMG-SIMG).

Dona D, Brigadoi G, Grandinetti R, Pedretti L, Boscarino G, Barbieri E Ital J Pediatr. 2024; 50(1):217.

PMID: 39427174 PMC: 11491012. DOI: 10.1186/s13052-024-01786-8.

Controversies in Antibiotic Use for Chronic Wet Cough in Children.

Liptzin D, Neemann K, McCulloh R, Singleton R, Smith P, Carlson J J Pediatr. 2023; 264:113762.

PMID: 37778412 PMC: 11216076. DOI: 10.1016/j.jpeds.2023.113762.

Short-term antibiotic therapy for the most common bacterial respiratory infections in infants and children.

Principi N, Autore G, Argentiero A, Esposito S Front Pharmacol. 2023; 14:1174146.

PMID: 37346296 PMC: 10279853. DOI: 10.3389/fphar.2023.1174146.

References

Bradley J, Byington C, Shah S, Alverson B, Carter E, Harrison C . The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011; 53(7):e25-76. PMC: 7107838. DOI: 10.1093/cid/cir531. View

Hanretty A, Gallagher J . Shortened Courses of Antibiotics for Bacterial Infections: A Systematic Review of Randomized Controlled Trials. Pharmacotherapy. 2018; 38(6):674-687. DOI: 10.1002/phar.2118. View

Spellberg B . The New Antibiotic Mantra-"Shorter Is Better". JAMA Intern Med. 2016; 176(9):1254-5. PMC: 5233409. DOI: 10.1001/jamainternmed.2016.3646. View

Butler J, Hofmann J, Cetron M, Elliott J, Facklam R, Breiman R . The continued emergence of drug-resistant Streptococcus pneumoniae in the United States: an update from the Centers for Disease Control and Prevention's Pneumococcal Sentinel Surveillance System. J Infect Dis. 1996; 174(5):986-93. DOI: 10.1093/infdis/174.5.986. View

Arason V, Kristinsson K, Sigurdsson J, Stefansdottir G, Molstad S, Gudmundsson S . Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study. BMJ. 1996; 313(7054):387-91. PMC: 2351797. DOI: 10.1136/bmj.313.7054.387. View

Sinaniotis C, Sinaniotis A . Community-acquired pneumonia in children. Curr Opin Pulm Med. 2005; 11(3):218-25. DOI: 10.1097/01.mcp.0000159831.82529.85. View

Williams D, Creech C, Walter E, Martin J, Gerber J, Newland J . Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial. JAMA Pediatr. 2022; 176(3):253-261. PMC: 8767493. DOI: 10.1001/jamapediatrics.2021.5547. View

Greenberg D, Givon-Lavi N, Sadaka Y, Ben-Shimol S, Bar-Ziv J, Dagan R . Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: a double-blind, randomized, placebo-controlled trial. Pediatr Infect Dis J. 2013; 33(2):136-42. DOI: 10.1097/INF.0000000000000023. View

Pernica J, Harman S, Kam A, Carciumaru R, Vanniyasingam T, Crawford T . Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial. JAMA Pediatr. 2021; 175(5):475-482. PMC: 7941245. DOI: 10.1001/jamapediatrics.2020.6735. View

10.

Bielicki J, Stohr W, Barratt S, Dunn D, Naufal N, Roland D . Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA. 2021; 326(17):1713-1724. PMC: 8564579. DOI: 10.1001/jama.2021.17843. View

11.

Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H . Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008; 86(5):408-16. PMC: 2647437. DOI: 10.2471/blt.07.048769. View

12.

Lichenstein R, Suggs A, Campbell J . Pediatric pneumonia. Emerg Med Clin North Am. 2003; 21(2):437-51. DOI: 10.1016/s0733-8627(03)00008-7. View

13.

Hoppe J . Rational prescribing of antibacterials in ambulatory children. Pharmacoeconomics. 1996; 10(6):552-74. DOI: 10.2165/00019053-199610060-00004. View

14.

Bhutta Z . Dealing with childhood pneumonia in developing countries: how can we make a difference?. Arch Dis Child. 2007; 92(4):286-8. PMC: 2083673. DOI: 10.1136/adc.2006.111849. View

15.

Ambroggio L, Mangeot C, Kurowski E, Graham C, Korn P, Strasser M . Guideline Adoption for Community-Acquired Pneumonia in the Outpatient Setting. Pediatrics. 2018; 142(4). DOI: 10.1542/peds.2018-0331. View

16.

Messinger A, Kupfer O, Hurst A, Parker S . Management of Pediatric Community-acquired Bacterial Pneumonia. Pediatr Rev. 2017; 38(9):394-409. DOI: 10.1542/pir.2016-0183. View

17.

Qazi S . Short-course therapy for community-acquired pneumonia in paediatric patients. Drugs. 2005; 65(9):1179-92. DOI: 10.2165/00003495-200565090-00001. View