Elizabeth E Dawson-Hahn1,2, Sharon Mickan3,4, Igho Onakpoya4, Nia Roberts5, Matthew Kronman1,6, Chris C Butler4,7, Matthew J Thompson8. 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.
Abstract
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.
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.
Authors: Lionel A Mandell; Richard G Wunderink; Antonio Anzueto; John G Bartlett; G Douglas Campbell; Nathan C Dean; Scott F Dowell; Thomas M File; Daniel M Musher; Michael S Niederman; Antonio Torres; Cynthia G Whitney Journal: Clin Infect Dis Date: 2007-03-01 Impact factor: 9.079
Authors: Eugene A Katchman; Gai Milo; Mical Paul; Thierry Christiaens; Anders Baerheim; Leonard Leibovici Journal: Am J Med Date: 2005-11 Impact factor: 4.965
Authors: Stanford T Shulman; Gene Stollerman; Bernard Beall; James B Dale; Robert R Tanz Journal: Clin Infect Dis Date: 2006-01-17 Impact factor: 9.079
Authors: Beverley J Shea; Jeremy M Grimshaw; George A Wells; Maarten Boers; Neil Andersson; Candyce Hamel; Ashley C Porter; Peter Tugwell; David Moher; Lex M Bouter Journal: BMC Med Res Methodol Date: 2007-02-15 Impact factor: 4.615
Authors: Jesús López-Alcalde; Ricardo Rodriguez-Barrientos; Jesús Redondo-Sánchez; Javier Muñoz-Gutiérrez; José María Molero García; Carmen Rodríguez-Fernández; Julio Heras-Mosteiro; Jaime Marin-Cañada; Jose Casanova-Colominas; Amaya Azcoaga-Lorenzo; Virginia Hernandez Santiago; Manuel Gómez-García Journal: Cochrane Database Syst Rev Date: 2018-09-06
Authors: Igho J Onakpoya; A Sarah Walker; Pui S Tan; Elizabeth A Spencer; Oghenekome A Gbinigie; Johanna Cook; Martin J Llewelyn; Christopher C Butler Journal: PLoS One Date: 2018-03-28 Impact factor: 3.240
Authors: Koen B Pouwels; Mo Yin; Christopher C Butler; Ben S Cooper; Sarah Wordsworth; A Sarah Walker; Julie V Robotham Journal: BMC Med Date: 2019-06-21 Impact factor: 8.775
Authors: Ria Benko; Maria Matuz; Zoltan Juhasz; Julia Bognar; Reka Bordas; Gyongyver Soos; Edit Hajdu; Zoltan Peto Journal: Front Pharmacol Date: 2019-12-19 Impact factor: 5.810
Authors: Jannicke Slettli Wathne; Brita Skodvin; Esmita Charani; Stig Harthug; Hege Salvesen Blix; Roy M Nilsen; Lars Kåre Selland Kleppe; Marta Vukovic; Ingrid Smith Journal: Antimicrob Resist Infect Control Date: 2020-07-21 Impact factor: 4.887