Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign

Furlan, Ludovico; Erba, Luca; Trombetta, Lucia; Sacco, R.; Colombo, G; Casazza, Giovanni; Solbiati, Monica; Montano, Nicola; Marta, Chiara; Sbrojavacca, Rodolfo; Perticone, Francesco; Corazza, Gino Roberto; Costantino, Giorgio

doi:10.1007/s11739-018-1955-2

Cited by 9 publications

(9 citation statements)

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“…This is in line with the previous pairwise meta-analyses that showed shorter duration was non-inferior to longer duration. [10][11][12] We updated the systematic review and found four trials that were not included in the previous studies. This allowed us to focus on trials that used the same antibiotics with the same daily dosage.…”

Section: Discussionmentioning

confidence: 99%

“…Several meta-analyses have been reported on this topic. [10][11][12] A major limitation of the method used in the previous pairwise meta-analyses is the arbitrary categorisation of duration when the original studies compared different duration, ranging from 3 to 10 days. A pairwise meta-analysis published in 2008, 10 for example, categorised a 7-day treatment arm in one trial as short-course and the same in other two trials as long-course.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“… 11 The duration range of short-course therapy defined by a systematic review of systematic reviews and guidelines with pairwise meta-analyses in 2019 was wide (3–7 days) and the duration-effect relationship within that range remains unclear. 12 We overcame the limitation of arbitrary dichotomisation of duration by using a novel method called dose-effect meta-analysis. 16 It has been used, for example, to examine the effects of potassium intake or sodium reduction on blood pressure.…”

Section: Introductionmentioning

confidence: 99%

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Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis

et al. 2023

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ObjectivesTo find the optimal treatment duration with antibiotics for community-acquired pneumonia (CAP) in adults.DesignSystematic review and duration-effect meta-analysis.Data sourcesMEDLINE, Embase and CENTRAL through 25 August 2021.Eligibility criteriaAll 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 synthesisData 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).ResultsWe 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%).ConclusionsShorter 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 numberCRD 42021273357.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis

et al. 2023

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“…Insiden CAP pada pasien rawat jalan dan rawat inap rumah sakit diketahui 5-10 per 1000 pada populasi orang dewasa (Furlan et al, 2019). Pada tahun 2010, studi global mengenai beban penyakit melaporkan bahwa pneumonia yang termasuk dalam infeksi saluran pernapasan bawah merupakan penyebab kematian keempat di dunia dan menempatkan beban signifikan pada perawatan kesehatan (Lopardo et al, 2018;Lozano et al, 2012 ).…”

Section: Pendahuluanunclassified

Comparison between monotherapy and combination therapy among inpatients with community-acquired pneumonia

Syahniar

Nabila

Kharisma

et al. 2021

JIF

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Background: Pneumonia causes high mortality, hospitalization costs and health services. There is some growing debate regarding the efficacy of different treatment management approaches. The use of certain antibiotic regimens combination and monotherapy have been associated with improved outcomes. Objective: This study aims to determine the effectiveness of monotherapy and combination therapy on length of stay. Method: This retrospective study included patients with Community Acquired Pneumonia (CAP) who received empirical therapy between January - December 2017 at Jakarta Islamic Hospital of Cempaka Putih. Two hundred and ninety four subjects were included in this study. Results: Subjects who received monotherapy and combination therapy were 73.8% and 26.2%. Mean length of stay was 5 days. The most widely used antibiotic in this study was ceftriaxone with levofloxacin (35%) for combination therapy and levofloxacin (38,2%) for monotherapy. There is a relationship between comorbidities and long-term hospitalization (p=0.008). Conclusion: There was no significant difference between combination therapy and monotherapy with length of stay (p=0.277). Keywords: Pneumonia, monotherapy, combination therapy, Jakarta Islamic Hospital of Cempaka Putih

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“…Although previous systematic reviews, and overviews of reviews, have examined shorter versus longer duration of therapy for CAP,10 11 22–26 they have not evaluated durations less than five days,11 23 25 or are limited to a comparison of two durations with the same drug across arms 26. A recent review by Tansarli and colleagues in 2018 found no significant difference in clinical cure, fewer adverse events and lower mortality associated with shorter (≤six days) versus longer courses of therapy (≥seven days), irrespective of patient setting or severity of pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis

et al. 2022

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IntroductionCommunity-acquired pneumonia (CAP), frequently encountered in both outpatient and inpatient settings, is the leading cause of infectious disease-related mortality. While equipoise regarding the optimal duration of antimicrobial therapy to treat CAP remains, recent studies suggest shorter durations of therapy may achieve optimal outcomes. We have therefore planned a systematic review and meta-analysis evaluating the impact of shorter versus longer durations of antibiotic therapy for patients with CAP.Methods and analysisWe searched Ovid MEDLINE, Embase, CINAHL and Cochrane Central Register of Controlled Trials from inception to September 2021 for randomised controlled trials evaluating shorter versus longer duration of antibiotics. Eligible studies will compare durations with a minimum difference of two days of antibiotic therapy, irrespective of antibiotic agent, class, route, frequency or dosage, and will report on any patient-important outcome of benefit or harm. Paired reviewers working independently will conduct title and abstract screening, full-text screening, data extraction and risk of bias (RoB) evaluation using a modified Cochrane RoB 2.0 tool. We will perform random-effects modelling for meta-analyses, with study weights generated using the inverse variance method, and will assess certainty in effect estimates using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) tool will inform assessments of credibility of subgroup effects based on severity of illness, drug class, duration of therapy, setting of CAP acquisition and RoB.Ethics and disseminationThe results will be of importance to general practitioners and internists managing CAP, and may directly inform international clinical guidance. Where concerns regarding antimicrobial resistance continue to grow internationally, this evidence summary may motivate new recommendations regarding shorter durations of therapy. We intend to disseminate our findings via national and international conferences, and publication in a peer-reviewed journal.PROSPERO registration numberCRD42021283990.

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Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign

Cited by 9 publications

References 67 publications

Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis

Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis

Comparison between monotherapy and combination therapy among inpatients with community-acquired pneumonia

Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis

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