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A narrative review of short- versus long-course antibiotic treatment for community-acquired pneumonia in the outpatient pediatric setting

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2022. Ressources en ligne : Abrégé : Background. Clinical practices regarding the duration of antibiotics used for community-acquired pneumonia (CAP) in children vary between settings. This could contribute to adverse drug reactions, treatment failure, and antimicrobial resistance. Methods. The following search tools were used for this narrative literature review: PubMed, TRIP, and Medline/Ovid. The keywords included were “pneumonia”, “pediatric”, “treatment”, “duration”, “child”, “days”, “community-acquired pneumonia”, “short”, “non-severe”, “amoxicillin dose”, and “pneumonia children”, and the selection of articles was limited to the last 10 years, from 2011 to 2021. Results. We found 15 studies that assessed short (3 or 5 days) versus longer (7 or 10 days) durations of antibiotic treatment in pediatric outpatient CAP. Of these, we selected 8 studies: 5 completed randomized controlled trials (RCTs), 2 ongoing RCTs, and 1 retrospective cohort study. Discussion. Our review shows that short-course antimicrobial therapy for outpatient pediatric CAP is a promising option for maximizing efficacy, while also minimizing adverse effects, non-adherence, and antimicrobial resistance. Half of the RCTs showed that a short-course treatment with oral amoxicillin, the reference antibiotic, had a comparable efficacy to longer course treatment. However, in these studies, bacterial CAP was not easily established, and there was considerable variability in the diagnosis and interpretation of radiological findings. Conclusion. The results from the studies included in this narrative review are informative and add to our understanding of outpatient pediatric CAP. They highlight the importance of maintaining an effective balance, where a clinician can aim to minimize antimicrobial overuse and risk of resistance while maximizing efficacy. Although these studies look promising, future research is required in pediatric patients with CAP, and these studies must be capable of addressing the limitations listed in this paper.
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Background. Clinical practices regarding the duration of antibiotics used for community-acquired pneumonia (CAP) in children vary between settings. This could contribute to adverse drug reactions, treatment failure, and antimicrobial resistance. Methods. The following search tools were used for this narrative literature review: PubMed, TRIP, and Medline/Ovid. The keywords included were “pneumonia”, “pediatric”, “treatment”, “duration”, “child”, “days”, “community-acquired pneumonia”, “short”, “non-severe”, “amoxicillin dose”, and “pneumonia children”, and the selection of articles was limited to the last 10 years, from 2011 to 2021. Results. We found 15 studies that assessed short (3 or 5 days) versus longer (7 or 10 days) durations of antibiotic treatment in pediatric outpatient CAP. Of these, we selected 8 studies: 5 completed randomized controlled trials (RCTs), 2 ongoing RCTs, and 1 retrospective cohort study. Discussion. Our review shows that short-course antimicrobial therapy for outpatient pediatric CAP is a promising option for maximizing efficacy, while also minimizing adverse effects, non-adherence, and antimicrobial resistance. Half of the RCTs showed that a short-course treatment with oral amoxicillin, the reference antibiotic, had a comparable efficacy to longer course treatment. However, in these studies, bacterial CAP was not easily established, and there was considerable variability in the diagnosis and interpretation of radiological findings. Conclusion. The results from the studies included in this narrative review are informative and add to our understanding of outpatient pediatric CAP. They highlight the importance of maintaining an effective balance, where a clinician can aim to minimize antimicrobial overuse and risk of resistance while maximizing efficacy. Although these studies look promising, future research is required in pediatric patients with CAP, and these studies must be capable of addressing the limitations listed in this paper.

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