A Cochrane review [Abstract] 1 included 4 studies with a total of 6177 subjects. Non-severe pneumonia was defined according to WHO algorithm as cough or difficult and fast breathing (respiratory rate of 50 breaths per minute or more for children aged 2 months to 11 months, or respiratory rate of 40 breaths per minute or more for children aged 12 months to 59 months). No laboratory or radiographic tests were performed. Analysis of three days versus five days of treatment with the same antibiotic for non-severe pneumonia in children showed non-significant differences in rates of clinical cure at the end of treatment (RR 0.99, 95% CI 0.97 to 1.01), treatment failure at the end of treatment (RR 1.07, 95% CI 0.92 to 1.25) and relapse rate after seven days of clinical cure (RR 1.09, 95% CI 0.83 to 1.42). The antibiotic used was amoxicillin in 2 studies and cotrimoxazole (trimethoprim-sulfamethoxazole combination) in 2 studies. Subgroup analysis evaluating the impact of different antibiotics showed non-significant differences for these outcomes with different durations of therapy. Data were not available on outcomes of mortality at one month and additional interventions.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
Clinical comment: Effective shortened durations of antibiotic therapy for community-acquired pneumonia would be especially beneficial for low-income countries as it would lead to a reduction in the overall cost of treatment, improved compliance and tolerance of treatment and reduced antimicrobial resistance. This question is less relevant in developed countries, where pneumonia is less common, diagnostic facilities are better and the duration of antibiotic treatment can be better adjusted by the clinical course of the disease. The diagnosis according to WHO criteria is unspecific, and it is likely that most of the children in these studies did not suffer from bacterial pneumonia.
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