1. Fam Pract. 2017 Sep 1;34(5):511-519. doi: 10.1093/fampra/cmx037.

Short-course versus long-course oral antibiotic treatment for infections treated 
in outpatient settings: a review of systematic reviews.

Dawson-Hahn EE(1)(2), Mickan S(3)(4), Onakpoya I(4), Roberts N(5), Kronman
M(1)(6), Butler CC(4)(7), Thompson MJ(8).

Author information: 
(1)Department of Pediatrics, University of Washington, Seattle, WA, USA.
(2)Center for Child Health, Behavior and Development, Seattle Children's Research
Institute, Seattle, WA, USA.
(3)Gold Coast Health and Griffith University, Queensland, Australia.
(4)Nuffield Department of Primary Care Health Sciences, University of Oxford,
Oxford, UK.
(5)Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
(6)Division of Infectious Diseases, Seattle Children's Hospital, Seattle, WA,
USA.
(7)Primary Care Medicine, Cardiff University, Cardiff, Wales, UK.
(8)Department of Family Medicine, University of Washington, Seattle, WA, USA.

Purpose: To summarize the evidence comparing the effectiveness of short and long 
courses of oral antibiotics for infections treated in outpatient settings.
Methods: We identified systematic reviews of randomized controlled trials for
children and adults with bacterial infections treated in outpatient settings from
Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews and The Database
of Review of Effects. Data were extracted on the primary outcome of clinical
resolution and secondary outcomes.
Results: We identified 30 potential reviews, and included 9. There was no
difference in the clinical cure for children treated with short or long course
antibiotics for Group A streptococcal tonsillopharyngitis (OR 1.03, 95% CI:0.97, 
1.11); community acquired pneumonia (RR 0.99, 95% CI:0.97, 1.01); acute otitis
media [<2 years old OR: 1.09 (95% CI:0.76, 1.57); ≥2 years old OR: 0.85 (95%
CI:0.60, 1.21)]; or urinary tract infection (RR 1.06, 95% CI:0.64, 1.76). There
was no difference in the clinical cure for adults treated with short or long
course antibiotics for acute bacterial sinusitis (RR 0.95, 95% CI:0.81, 1.21);
uncomplicated cystitis in non-pregnant women (RR 1.10, 95% CI:0.96, 1.25), or
elderly women (RR: 0.98, 95% CI:0.62, 1.54); acute pyelonephritis (RR 1.03, 95%
CI:0.80, 1.32); or community acquired pneumonia (RR: 0.96, 95% CI:0.74, 1.26). We
found inadequate evidence about the effect on antibiotic resistance.
Conclusions: This overview of systematic reviews has identified good quality
evidence that short course antibiotics are as effective as longer courses for
most common infections managed in ambulatory care. The impact on antibiotic
resistance and associated treatment failure requires further study.

© The Author 2017. Published by Oxford University Press. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/fampra/cmx037 
PMID: 28486675  [Indexed for MEDLINE]