A Cochrane review[Abstract] 1 included 49 studies with a total of 12 045 subjects. The following antibiotics were evaluated: amoxicillin or amoxicillin/clavulanate (32 studies), azithromycin (21), cefaclor (8), cefdinir (2), cefixime (2), cefpodoxime (4), cefprozil (2), cefuroxime (3), ceftriaxone (9), clarithromycin (1), penicillin (3), and trimethoprim-sulfamethoxazole (1). Short-course interventions were primarily a three to five-day regimen.
Risk of treatment failure was higher with short courses (less than seven days) of antibiotics (OR 1.34, 95% CI 1.15 to 1.55; 16 studies, n=5 093) at one month after initiation of therapy (21% failure with short-course treatment and 18% with long-course; absolute difference of 3% between groups). Significant results were found when treatment failure was compared at a follow-up period of 19 days or less (OR 1.37, 95% CI 1.15 to 1.64; 11 studies, n=3 932). At 20 to 30 days there was no difference in the risk of treatment failure between short and long-course antibiotics (OR 1.16, 95% CI 0.94 to 1.42; 9 studies, n=2 476). At one month or less, 22 children needed treatment with short regimens of antibiotics to cause an additional treatment failure compared to longer regimens of antibiotics.
There were no differences found when examining treatment with ceftriaxone for less than seven days (30% failure in those receiving ceftriaxone and 27% in short-acting antibiotics administered for seven days or more; OR 1.07, 95% CI 0.86 to 1.33; 8 studies, n=1 709) or azithromycin for less than seven days (18% failure in both those receiving azithromycin and short-acting antibiotics administered for seven days or more; OR 1.02, 95% CI 0.87 to 1.20; 19 studies, n=4 354) with respect to risk of treatment failure at one month or less. Significant reductions in gastrointestinal adverse events were observed for treatment with short-acting antibiotics and azithromycin.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding).
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