Short-course versus long-course intravenous treatment with the same antibiotic for severe community-acquired pneumonia in children aged 2 to 59 months

Review question

We conducted this review to see if there are any differences in the outcomes of treatment with a short (two to three days) compared to a long (five days) course of intravenous antibiotics for severe pneumonia.

Background

Infection of the lungs (also known as pneumonia) remains the single leading cause of childhood mortality, causing an estimated 1.3 million deaths each year in children younger than five years of age. The greater burden of disease occurs in low-income countries, where medical resources and hospital-based management are poor. Current World Health Organization (WHO) evidence summaries recommend five days of intravenous antibiotics for children suffering from severe pneumonia. Approximately 120 million new cases of pneumonia occur globally each year in children aged less than five years, of which 14 million progress to severe episodes. Hospitalisation for severe pneumonia in children places a significant burden on both patients and their families, including substantial expense, loss of routine and decrease in quality of life. By reducing the duration of treatment in the hospital, this burden could potentially be lessened and possibly lead to better treatment compliance.

Key results
Our evidence is current to February 2015. We did not identify any relevant studies. We recommend that physicians should continue to treat severe pneumonia as per the WHO recommendations until further evidence is available.

Authors' conclusions: 

We did not identify any RCTs comparing a short course (two to three days) of intravenous antibiotics compared to a long course (five days) for severe pneumonia in children aged two to 59 months.

Read the full abstract...
Background: 

Pneumonia remains the single leading cause of childhood mortality, causing an estimated 1.3 million childhood deaths each year in children under the age of five years. The greater burden of disease occurs in low-income countries, where medical resources and hospital-based management are poor. The World Health Organization (WHO) current evidence summaries recommend intravenous antibiotics for five days as first-line treatment for severe pneumonia. Although there is controversy around the specificity of clinical features in the diagnosis of pneumonia, the criteria for the diagnosis of severe pneumonia are better defined and widely used to triage children for referral and second-line therapy.

Approximately 120 million new cases of pneumonia occur globally each year in children under five years of age, of which 14 million progress to severe episodes. Hospitalisation for severe pneumonia in children places a significant burden on both patients and their families, including substantial expense, loss of routine and decrease in quality of life. By reducing the duration of treatment in the hospital, this burden could potentially be lessened and possibly lead to better treatment compliance.

Objectives: 

To evaluate the efficacy of short-course (two to three days) versus long-course (five days) intravenous therapy with the same antibiotic for severe community-acquired pneumonia (CAP) in children aged two months to 59 months.

Search strategy: 

We searched CENTRAL (2015, Issue 1), MEDLINE (1966 to January week 4, 2015) and EMBASE (1974 to February 2015).

Selection criteria: 

Randomised controlled trials (RCTs) evaluating the efficacy of short-course (two to three days) versus long-course (five days) intravenous antibiotic therapy for severe pneumonia in children aged two months to 59 months. We excluded children with any other debilitating disease, including those infected with HIV and we excluded children with signs and symptoms of very severe pneumonia (i.e. unable to drink or breast feed, vomiting, lethargic, unconscious, convulsing, central cyanosis, severe respiratory distress or clinically severe malnutrition). We also excluded children who had developed pneumonia during their hospital stay (i.e. with nosocomial infection). There was no restriction on the type of antibiotic used, the dose or the frequency of dosing.

Data collection and analysis: 

We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results: 

We identified 2352 studies, however none fulfilled our pre-defined inclusion criteria.