Abstract
Our objective was to assess the clinical effectiveness of shorter versus longer duration antibiotics for treatment of bacterial infections in adults and children in secondary care settings, using the evidence from published systematic reviews. We conducted electronic searches in MEDLINE, Embase, Cochrane, and Cinahl. Our primary outcome was clinical resolution. The quality of included reviews was assessed using the AMSTAR criteria, and the quality of the evidence was rated using the GRADE criteria. We included 6 systematic reviews (n = 3,162). Four reviews were rated high quality, and two of moderate quality. In adults, there was no difference between shorter versus longer duration in clinical resolution rates for peritonitis (RR 1.03, 95% CI 0.98 to 1.09, I2 = 0%), ventilator-associated pneumonia (RR 0.93; 95% CI 0.81 to 1.08, I2 = 24%), or acute pyelonephritis and septic UTI (clinical failure: RR 1.00, 95% CI 0.46 to 2.18). The quality of the evidence was very low to moderate. In children, there was no difference in clinical resolution rates for pneumonia (RR 0.98, 95% CI 0.91 to 1.04, I2 = 48%), pyelonephritis (RR 0.95, 95% CI 0.88 to 1.04) and confirmed bacterial meningitis (RR 1.02, 95% CI 0.93 to 1.11, I2 = 0%). The quality of the evidence was low to moderate. In conclusion, there is currently a limited body of evidence to clearly assess the clinical benefits of shorter versus longer duration antibiotics in secondary care. High quality trials assessing strategies to shorten antibiotic treatment duration for bacterial infections in secondary care settings should now be a priority.
Highlights
The UK government [1] and WHO [2] recognise that antimicrobial resistance is one of the most important global public health threats that leads to mounting healthcare costs, treatment failure, increased morbidity and excess deaths [2,3]
Ten articles were excluded because the report did not provide appropriate data for comparison (n = 1) [39]; the comparison was intermittent versus continuous infusion (n = 2) [40,41]; different antibiotic combinations were compared (n = 1) [42]; not a conventional systematic review (n = 1) [43]; antibiotics were compared with placebo or other interventions (n = 1) [44]; reviews were older, less comprehensive reviews of other articles assessing the same condition that was included in the overview (n = 3) [45,46,47] and because the overall duration of antibiotic therapy was similar across the intervention groups (n = 1) [48]
The medical conditions examined in systematic reviews involving adults included peritonitis, pyelonephritis, pneumonia and intra-amniotic infection
Summary
The UK government [1] and WHO [2] recognise that antimicrobial resistance is one of the most important global public health threats that leads to mounting healthcare costs, treatment failure, increased morbidity and excess deaths [2,3]. Onakpoya et al/shorter vs longer duration antibiotic therapy. National Health Service, the National Institute for Health Research or the Department of Health. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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