Short-Course vs Long-Course Antibiotic Therapy for Children With Nonsevere Community-Acquired Pneumonia A Systematic Review and Meta-analysis

作者全名："Li, Qinyuan; Zhou, Qi; Florez, Ivan D.; Mathew, Joseph L.; Shang, Lianhan; Zhang, Guangli; Tian, Xiaoyin; Fu, Zhou; Liu, Enmei; Luo, Zhengxiu; Chen, Yaolong"

作者地址："[Luo, Zhengxiu] Chongqing Med Univ, Dept Resp Med, Childrens Hosp, 136 Zhongshan 2nd Rd, Chongqing 400010, Peoples R China; [Chen, Yaolong] Lanzhou Univ, Sch Basic Med Sci, 199 Donggang West Rd, Lanzhou 730000, Peoples R China; [Li, Qinyuan; Zhang, Guangli; Tian, Xiaoyin; Fu, Zhou; Liu, Enmei; Luo, Zhengxiu] Chongqing Med Univ, Dept Resp Med, Childrens Hosp, Chongqing, Peoples R China; [Li, Qinyuan; Zhang, Guangli; Tian, Xiaoyin; Fu, Zhou; Liu, Enmei; Luo, Zhengxiu] Natl Clin Res Ctr Child Hlth & Disorders, Chongqing, Peoples R China; [Li, Qinyuan; Zhang, Guangli; Tian, Xiaoyin; Fu, Zhou; Liu, Enmei; Luo, Zhengxiu] Minist Educ, Key Lab Child Dev & Disorders, Chongqing, Peoples R China; [Li, Qinyuan; Zhang, Guangli; Tian, Xiaoyin; Fu, Zhou; Liu, Enmei; Luo, Zhengxiu] Chongqing Key Lab Pediat, Chongqing, Peoples R China; [Zhou, Qi; Chen, Yaolong] Lanzhou Univ, Evidence Based Med Ctr, Sch Basic Med Sci, Lanzhou, Peoples R China; [Florez, Ivan D.] McMaster Univ, Sch Rehabil Sci, Hamilton, ON, Canada; [Florez, Ivan D.] Univ Antioquia, Dept Pediat, Medellin, Antioquia, Colombia; [Florez, Ivan D.] Lanzhou Univ, Cochrane China Network, Lanzhou, Peoples R China; [Mathew, Joseph L.] Lanzhou Univ, GRADE Ctr, Lanzhou, Peoples R China; [Shang, Lianhan] Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England; [Chen, Yaolong] Chongqing Med Univ, Chevidence Lab Child & Adolescent Hlth, Childrens Hosp, Chongqing, Peoples R China; [Chen, Yaolong] Lanzhou Univ, Chinese Acad Med Sci 2021RU017, Sch Basic Med Sci, Res Unit Evidence Based Evaluat & Guidelines, Lanzhou, Peoples R China"

通信作者："Luo, ZX (通讯作者)，Chongqing Med Univ, Dept Resp Med, Childrens Hosp, 136 Zhongshan 2nd Rd, Chongqing 400010, Peoples R China.; Chen, YL (通讯作者)，Lanzhou Univ, Sch Basic Med Sci, 199 Donggang West Rd, Lanzhou 730000, Peoples R China."

来源：JAMA PEDIATRICS

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000886754000001

JCR分区：Q1

影响因子：26.1

年份：2022

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Review; Early Access

关键词：　

摘要："IMPORTANCE Short-course antibiotic therapy could enhance adherence and reduce adverse drug effects and costs. However, based on sparse evidence, most guidelines recommend a longer course of antibiotics for nonsevere childhood community-acquired pneumonia (CAP). OBJECTIVE To determine whether a shorter course of antibiotics was noninferior to a longer course for childhood nonsevere CAP. DATA SOURCES MEDLINE, Embase, Web of Science, the Cochrane Library, and 3 Chinese databases from inception to March 31, 2022, as well as clinical trial registries and Google.com. STUDY SELECTION Randomized clinical trials comparing a shorter- vs longer-course therapy using the same oral antibiotic for children with nonsevere CAP were included. DATA EXTRACTION AND SYNTHESIS Random-effects models were used to pool the data, which were analyzed from April 15, 2022, to May 15, 2022. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence. MAIN OUTCOMES AND MEASURES Treatment failure, defined by persistence of pneumonia or the new appearance of any general danger signs of CAP (eg, lethargy, unconsciousness, seizures, or inability to drink), elevated temperature (> 38 & DEG;C) after completion of treatment, change of antibiotic, hospitalization, death, missing more than 3 study drug doses, loss to follow-up, or withdrawal of informed consent. RESULTS Nine randomized clinical trials including 11 143 participants were included in this meta-analysis. A total of 98% of the participants were aged 2 to 59 months, and 58% were male. Eight studies with 10 662 patients reported treatment failure. Treatment failure occurred in 12.8% vs 12.6% of participants randomized to a shorter vs a longer course of antibiotics. High-quality evidence showed that a shorter course of oral antibiotic was noninferior to a longer course with respect to treatment failure for children with nonsevere CAP (risk ratio, 1.01; 95% CI, 0.92-1.11; risk difference, 0.00; 95% CI, -0.01 to 0.01; I-2 = 0%). A 3-day course of antibiotic treatment was noninferior to a 5-day course for the outcome of treatment failure (risk ratio, 1.01; 95% CI, 0.91-1.12; I-2 = 0%), and a 5-day course was noninferior to a 10-day course (risk ratio, 0.87; 95% CI, 0.50-1.53; I-2 = 0%). A shorter course of antibiotics was associated with fewer reports of gastroenteritis (risk ratio, 0.79; 95% CI, 0.66-0.95) and lower caregiver absenteeism (incident rate ratio, 0.74; 95% CI, 0.65-0.84). CONCLUSION and Relevance Results of this meta-analysis suggest that a shorter course of antibiotics was noninferior to a longer course in children aged 2 to 59 months with nonsevere CAP. Clinicians should consider prescribing a shorter course of antibiotics for the management of pediatric nonsevere CAP."

基金机构："General Project from the National Clinical Research Center for Child Health and Disorders (Children's Hospital of Chongqing Medical University, Chongqing, China) [NCRCCHD-2020-GP-05]; Youth Project from the National Clinical Research Center for Child Health and Disorders [NCRCCHD-2021-YP-01]; General Basic Research Project from the Ministry of Education Key Laboratory of Child Development and Disorders [GBRP-202112]"

基金资助正文："This study was supported by a grant from the General Project from the National Clinical Research Center for Child Health and Disorders (Children's Hospital of Chongqing Medical University, Chongqing, China; NCRCCHD-2020-GP-05), the Youth Project from the National Clinical Research Center for Child Health and Disorders (NCRCCHD-2021-YP-01), and the General Basic Research Project from the Ministry of Education Key Laboratory of Child Development and Disorders (GBRP-202112)."