Shorter versus longer courses of antibiotics for infection in hospitalized patients: A systematic review and meta-analysis.
Open accessAbstract
BACKGROUND: Infection is a leading cause of hospitalization with high morbidity and mortality, but there are limited data to guide the duration of antibiotic therapy. PURPOSE: Systematic review to compare outcomes of shorter versus longer antibiotic courses among hospitalized adults and adolescents. DATA SOURCES: MEDLINE and Embase databases, 1990‐2017. STUDY SELECTION: Inclusion criteria were human randomized controlled trials (RCTs) in English comparing a prespecified short course of antibiotics to a longer course for treatment of infection in hospitalized adults and adolescents aged 12 years and older. DATA EXTRACTION: Two authors independently extracted study characteristics, methods of statistical analysis, outcomes, and risk of bias. DATA SYNTHESIS: Of 5187 unique citations identified, 19 RCTs comprising 2867 patients met our inclusion criteria, including the following: 9 noninferiority trials, 1 superiority design trial, and 9 pilot studies. Across 13 studies evaluating 1727 patients, no significant difference in clinical efficacy was observed (d = 1.6% [95% confidence interval (CI), ‐1.0%‐4.2%]). No significant difference was detected in microbiologic cure (8 studies, d = 1.2% [95% CI, ‐4.1%‐6.4%]), short‐term mortality (8 studies, d = 0.3% [95% CI, ‐1.2%‐1.8%]), longer‐term mortality (3 studies, d = ‐0.4% [95% CI, ‐6.3%‐5.5%]), or recurrence (10 studies, d = 2.1% [95% CI, ‐1.2%‐5.3%]). Heterogeneity across studies was not significant for any of the primary outcomes. CONCLUSIONS: Based on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized patients with common infections, including pneumonia, urinary tract infection, and intra‐abdominal infection, to achieve clinical and microbiologic resolution without adverse effects on mortality or recurrence.
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Restricting antimicrobial therapy to the shortest course associated with better outcomes is an important part of antimicrobial stewardship.
“Restricting antimicrobial therapy to the shortest course associated with better outcomes is an important part of antimicrobial stewardship [281–285].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [283]
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- Authors
- Royer, S., DeMerle, K. M., Dickson, R. P., & Prescott, H. C.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- University of Michigan (US)
- Corresponding author
- Royer, Stephanie
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2018-01-25
- Volume
- 13
- Issue
- 5
- Pages
- 336-342
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- PMC
- PMC5945333
- OpenAlex
- W2789810619
- Cited by
- 94
- References
- 49
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 14 · 2023: 6 · 2022: 14 · 2021: 12 · 2020: 17 · 2019: 7 · 2018: 10
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Hospital Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Pfizer
- National Heart, Lung, and Blood Institute (K23HL130641)
- National Institute of General Medical Sciences (K08GM115859)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Keywords
- antibiotic duration, short-course antibiotic therapy, hospitalized patients, bacterial infection, microbiologic cure, mortality, recurrent infections, pneumonia, urinary tract infection, intra-abdominal infection, antibiotic stewardship
- MeSH terms
- Anti-Infective Agents, Anti-Bacterial Agents, Hospitalization, Humans, Pneumonia, Time Factors
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