Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis
BACKGROUND: Infection is a leading cause of hospitalization with high morbidity and mortality, but there are limited data to guide the duration of antibiotic therapy.
PURPOSE: Systematic review to compare outcomes of shorter versus longer antibiotic courses among hospitalized adults and adolescents.
DATA SOURCES: MEDLINE and Embase databases, 1990-2017.
STUDY SELECTION: Inclusion criteria were human randomized controlled trials (RCTs) in English comparing a prespecified short course of antibiotics to a longer course for treatment of infection in hospitalized adults and adolescents aged 12 years and older.
DATA EXTRACTION: Two authors independently extracted study characteristics, methods of statistical analysis, outcomes, and risk of bias.
DATA SYNTHESIS: Of 5187 unique citations identified, 19 RCTs comprising 2867 patients met our inclusion criteria, including the following: 9 noninferiority trials, 1 superiority design trial, and 9 pilot studies. Across 13 studies evaluating 1727 patients, no significant difference in clinical efficacy was observed (d = 1.6% [95% confidence interval (CI), −1.0%-4.2%]). No significant difference was detected in microbiologic cure (8 studies, d = 1.2% [95% CI, −4.1%-6.4%]), short-term mortality (8 studies, d = 0.3% [95% CI, −1.2%-1.8%]), longer-term mortality (3 studies, d = −0.4% [95% CI, −6.3%-5.5%]), or recurrence (10 studies, d = 2.1% [95% CI, −1.2%-5.3%]). Heterogeneity across studies was not significant for any of the primary outcomes.
CONCLUSIONS: Based on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized patients with common infections, including pneumonia, urinary tract infection, and intra-abdominal infection, to achieve clinical and microbiologic resolution without adverse effects on mortality or recurrence.
© 2018 Society of Hospital Medicine
CONCLUSION
Based on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized adults and adolescents to achieve clinical and microbiologic resolution of common infections, including pneumonia, UTI, and intra-abdominal infection, without adverse effect on infection recurrence. Moreover, short- and longer-term mortality are indistinguishable after treatment courses of differing duration. There are limited data on the longer-term risks associated with antibiotic duration, such as secondary infection or the emergence of MDR organisms.
Acknowledgments
The authors would like to thank their research librarian, Marisa Conte, for her help with the literature search for this review.
Disclosure
Drs. Royer and Prescott designed the study, performed data analysis, and drafted the manuscript. Drs. DeMerle and Dickson revised the manuscript critically for intellectual content. Dr. Royer holds stock in Pfizer. The authors have no other potential financial conflicts of interest to report.
