According to the 2007 guidelines from the Infectious Diseases Society of America and the American Thoracic Society, adult patients with community‐acquired pneumonia (CAP) should be treated for a minimum of 5 days, have no more than 1 CAP‐associated sign of clinical instability, and remain afebrile for 48‐72 hours. However, some studies have shown that patients with CAP may be successfully treated with therapy for as short as 1 to 3 days. The potential implications of effective short‐course therapy for CAP include improved adherence to medications, decreased rates of antibiotic resistance, decreased side effects, decreased C. difficile infections, and reduced cost. We performed a systematic review to identify randomized controlled trials (RCTs) that have evaluated the efficacy of short‐course antibiotic therapy for CAP.
We searched the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Database of Abstracts of Reviews of Effects, HealthSTAR, and MEDLINE databases. We also manually searched references of selected articles to identify any additional studies. RCTs that compared antibiotic regimens of different durations for adult patients with CAP were selected. Two reviewers (S.M., D.R.) independently extracted data. RCTs were evaluated for study quality using the Jadad scoring system. RCTs with a Jadad score ≥ 3 were included for analysis.
Our review identified 20 RCTs that met the initial inclusion criteria. Nine RCTs had Jadad scores of 3 or more. The results are summarized in Table 1.
Patients with mild to moderate disease (eg, PSI I‐III) may be treated with antibiotic regimens as short as 1‐3 days, and the antibiotic of choice is often azithromycin. Patients with severe disease (eg, PSI IV‐V or inpatient) can be treated for as few as 5 days with high‐dose levofloxacin (750 mg) instead of standard‐dose levofloxacin (500 mg) for 10 days. Because not all antibiotics have been studied at shorter durations, clinicians should also consider the type of antibiotic when deciding on shorter‐course therapy.
S. Miller, none; D. Rhew, none.