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J Hosp Med. 2018 May 1;13(5):336-342. doi: 10.12788/jhm.2905. Epub 2018 Jan 25.

Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis.

Author information

1
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. Stephanie.Royer@cchmc.org.
2
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
3
Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
4
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
5
Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.

Abstract

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.

PMID:
29370318
PMCID:
PMC5945333
[Available on 2019-05-01]
DOI:
10.12788/jhm.2905

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