Antibiotics for Pneumonia: What’s the Best Length Of Time?

Antibiotics for PneumoniaWhat’s the best duration of treatment for community-acquired pneumonia?

Current guidelines suggest five to 14 days, but a study by San Francisco Veterans Affairs researchers suggests that adults with mild-to-moderate pneumonia can be treated safely and effectively in seven days or less.

The researchers examined 15 randomized, controlled trials involving almost 2,800 inpatients and outpatients. Four of the antibiotic classes most commonly used for community-acquired pneumonia (macrolides, fluoroquinolones, beta-lactams, and ketolides) were represented; most of the studies examined short-course macrolide antibiotics.

No significant differences were noted between short-course and extended-course regimens in terms of clinical success, mortality, bacteriological success, or adverse drug events. The results were consistent across a wide range of analyses, including individual antibiotic classes.

The researchers add a caveat: most of the trials had included only mild-to-moderate pneumonia, and elderly patients were generally underrepresented. Even in the inpatient studies, respiratory failure and septic shock were common exclusion criteria. Therefore, although the results of this meta-analysis should be generalizable to most adults, they cannot be extrapolated to patients with severe community-acquired pneumonia.

(Source: Am J Med 2007;120:783-790.)