Evaluating Short-Course Antibiotic Therapy for Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

Background: The optimal duration of antibiotic therapy for community-acquired pneumonia (CAP) in children remains uncertain. In this study, we aimed to evaluate whether short-course antibiotic therapy (≤6 days) is associated with poor clinical outcomes compared with long-course antibiotic therapy (>7 days) in children with CAP. Methods: A comprehensive search was conducted across databases, including PubMed, Embase, Cochrane Library, and KoreaMed. Studies comparing the efficacy and safety of short-course with long-course antibiotic regimens in children with CAP were eligible. We assessed the risk of bias using the RoB 2 and ROBINS-I tools. Study characteristics such as publication year, country, setting, study design and antibiotic regimens were recorded. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for clinical outcomes, including clinical cure, treatment failure, total adverse events, serious adverse events, relapse and hospitalization. The primary outcomes were clinical cure and treatment failure. Secondary outcomes included total and serious adverse events, relapse and hospitalization rates. Results: Seventeen studies comprising 155,944 children met the inclusion criteria, with 15 of these studies being randomized controlled trials. There were no significant differences between short-course and long-course treatments in clinical cure [21,156 patients; RR, 1.01 (95% CI, 0.97-1.05); P = 0.73; I2 = 81%], treatment failure [28,942 patients; RR, 0.88 (95% CI, 0.51-1.51); P = 0.64; I2= 94%] or total adverse events [24,446 children; RR, 0.94 (95% CI, 0.61-1.44); P = 0.77; I2 = 90%]. However, short-course treatment was associated with fewer serious adverse events [4194 patients; RR, 0.89 (95% CI, 0.79-0.99); P = 0.04; I2 = 11%]. Relapse rates were nominally lower with short-course treatment compared with long-course treatments (5.5% vs. 6.2%; P = 0.04). This difference was primarily observed in the subgroup analysis comparing 5-day treatments to ≥10-day treatments. Hospitalization rates were similar between the two groups [122,607 patients; RR, 1.20 (95% CI, 0.85-1.68); P = 0.29; I2 = 0%]. Conclusions: Short-course antibiotic treatment is as effective as long-course treatment for pediatric CAP in terms of clinical cure and treatment failure while resulting in fewer serious adverse events.