Abstract
Reduction of the inappropriate use of antibiotics in clinical practice is one of the main goals of the Società Italiana di Medicina Interna (SIMI) choosing wisely campaign. We conducted a systematic review of secondary studies (systematic reviews and guidelines) to verify what evidence is available on the duration of antibiotic treatment in Pneumonia. A literature systematic search was performed to identify all systematic reviews and the three most cited and recent guidelines that address the duration of antibiotic therapy in pneumonia. Moreover, a meta-analysis of non-duplicate data from randomized controlled trials (RCTs) considered in the enrolled systematic reviews was performed together with a trial sequential analysis to identify the need for further studies. Two systematic reviews on antibiotic duration in community-acquired pneumonia (CAP) for a total of 17 RCTs (2764 patients) were enrolled in our study. Meta-analysis of non-duplicate RCTs show a non-significant difference in rate of treatment failure between short (≤ 7 days) and long (> 7 days) antibiotic treatment course: RR 1.05 (95% CI, 0.82–1.36). The trial sequential analysis suggests that further data would not affect current evidence or become clinically relevant. Selected guidelines suggest consideration of a short course, with a low grade of evidence and without citing the already published systematic reviews. Antibiotic treatment of CAP for ≤ 7 days is not associated with a higher rate of treatment failure than longer courses and should thus be taken in consideration. Guidelines should upgrade the evidence on this topic.
| Original language | English |
|---|---|
| Pages (from-to) | 377-394 |
| Journal | Internal and Emergency Medicine |
| Volume | 14 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2019 |
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Keywords
- Antibiotic treatment
- Choosing wisely
- Guidelines
- Infection
- Pneumonia
- Systematic review
ASJC Scopus subject areas
- Internal Medicine
- Emergency Medicine
Cite this
Short- vs long-course antibiotic therapy for pneumonia : a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign. / Furlan, Ludovico; Erba, Luca; Trombetta, Lucia; Sacco, Roberto; Colombo, Giorgio; Casazza, Giovanni; Solbiati, Monica; Montano, Nicola; Marta, Chiara; Sbrojavacca, Rodolfo; Perticone, Francesco; Corazza, Gino Roberto; Costantino, Giorgio.
In: Internal and Emergency Medicine, Vol. 14, No. 3, 2019, p. 377-394.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Short- vs long-course antibiotic therapy for pneumonia
T2 - a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign
AU - Furlan, Ludovico
AU - Erba, Luca
AU - Trombetta, Lucia
AU - Sacco, Roberto
AU - Colombo, Giorgio
AU - Casazza, Giovanni
AU - Solbiati, Monica
AU - Montano, Nicola
AU - Marta, Chiara
AU - Sbrojavacca, Rodolfo
AU - Perticone, Francesco
AU - Corazza, Gino Roberto
AU - Costantino, Giorgio
PY - 2019
Y1 - 2019
N2 - Reduction of the inappropriate use of antibiotics in clinical practice is one of the main goals of the Società Italiana di Medicina Interna (SIMI) choosing wisely campaign. We conducted a systematic review of secondary studies (systematic reviews and guidelines) to verify what evidence is available on the duration of antibiotic treatment in Pneumonia. A literature systematic search was performed to identify all systematic reviews and the three most cited and recent guidelines that address the duration of antibiotic therapy in pneumonia. Moreover, a meta-analysis of non-duplicate data from randomized controlled trials (RCTs) considered in the enrolled systematic reviews was performed together with a trial sequential analysis to identify the need for further studies. Two systematic reviews on antibiotic duration in community-acquired pneumonia (CAP) for a total of 17 RCTs (2764 patients) were enrolled in our study. Meta-analysis of non-duplicate RCTs show a non-significant difference in rate of treatment failure between short (≤ 7 days) and long (> 7 days) antibiotic treatment course: RR 1.05 (95% CI, 0.82–1.36). The trial sequential analysis suggests that further data would not affect current evidence or become clinically relevant. Selected guidelines suggest consideration of a short course, with a low grade of evidence and without citing the already published systematic reviews. Antibiotic treatment of CAP for ≤ 7 days is not associated with a higher rate of treatment failure than longer courses and should thus be taken in consideration. Guidelines should upgrade the evidence on this topic.
AB - Reduction of the inappropriate use of antibiotics in clinical practice is one of the main goals of the Società Italiana di Medicina Interna (SIMI) choosing wisely campaign. We conducted a systematic review of secondary studies (systematic reviews and guidelines) to verify what evidence is available on the duration of antibiotic treatment in Pneumonia. A literature systematic search was performed to identify all systematic reviews and the three most cited and recent guidelines that address the duration of antibiotic therapy in pneumonia. Moreover, a meta-analysis of non-duplicate data from randomized controlled trials (RCTs) considered in the enrolled systematic reviews was performed together with a trial sequential analysis to identify the need for further studies. Two systematic reviews on antibiotic duration in community-acquired pneumonia (CAP) for a total of 17 RCTs (2764 patients) were enrolled in our study. Meta-analysis of non-duplicate RCTs show a non-significant difference in rate of treatment failure between short (≤ 7 days) and long (> 7 days) antibiotic treatment course: RR 1.05 (95% CI, 0.82–1.36). The trial sequential analysis suggests that further data would not affect current evidence or become clinically relevant. Selected guidelines suggest consideration of a short course, with a low grade of evidence and without citing the already published systematic reviews. Antibiotic treatment of CAP for ≤ 7 days is not associated with a higher rate of treatment failure than longer courses and should thus be taken in consideration. Guidelines should upgrade the evidence on this topic.
KW - Antibiotic treatment
KW - Choosing wisely
KW - Guidelines
KW - Infection
KW - Pneumonia
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85055017349&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055017349&partnerID=8YFLogxK
U2 - 10.1007/s11739-018-1955-2
DO - 10.1007/s11739-018-1955-2
M3 - Article
AN - SCOPUS:85055017349
VL - 14
SP - 377
EP - 394
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
SN - 1828-0447
IS - 3
ER -