Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children

Abstract

Purpose of reviewCommunity-acquired pneumonia (CAP) and urinary tract infections (UTI) are two common childhood infections often leading to hospital admission. National guidelines for CAP and UTI in children recommend durations of antibiotic therapy of 10 days and 7–14 days, respectively. Due to concerns of rising antimicrobial resistance and an increased awareness of harms associated with prolonged courses of antibiotics, there is a renewed emphasis on reevaluating commonly prescribed durations of antibiotic therapy across bacterial infections. We describe recent clinical trials and observational studies evaluating durations of therapy for CAP and UTI in adults and children and translate the findings to our suggested approach for selecting durations of antibiotic therapy in hospitalized children.Recent findingsThere is a growing body of evidence, primarily in adults, that shorter durations of therapy than are commonly prescribed are just as effective as longer durations for CAP and UTIs.SummaryCombining clinical trial data from adults with available data in children, we believe it is reasonable to consider 5 days of therapy for CAP, 3–5 days of therapy for cystitis, and 7 days of therapy for pyelonephritis for most hospitalized children with uncomplicated infections.

Comparison between Short Therapy and Standard Therapy in Pediatric Patients Hospitalized with Urinary Tract Infection: A Single Center Retrospective Analysis

“…Importantly, our findings and the other mentioned studies seem to be in line with new evidence about the safety of short therapy in pediatric infectious diseases, such as pneumonia [ 10 ]: a recent review considered four clinical trials [ 23 , 24 , 25 , 26 ] aimed at analyzing the optimal duration of antibiotic therapy in children affected by non-hospitalized pneumonia, the conclusions of which are the same and indicate that in uncomplicated forms 5 days of antibiotic therapy are sufficient in the eradication of the infection. A similar conclusion can be applied to hospitalized patients [ 27 ] from a large multicenter study conducted in 2022, which showed that, in uncomplicated pneumonia cases, a 13–14-day cycle (defined as extended) does not exceed a standard 5–6-day cycle in healing at one month (extended course: n = 127/163, 77.9%; standard course: n = 131/161, 81%).…”

“…There was no significant difference in the odds of a drug-resistant uropathogen for patients with a subsequent urinary tract infection within 30 days when prescribed a short course vs. a prolonged course of antibiotics (40% vs. 64%; odds ratio, 0.36; 95% CI, 0.09–1.43). However, this study did not included infants younger than 6 months of age, which are a population at higher risk of UTIs, and considered a relatively long period of antibiotic duration (6–9 days) as a short day course, which is longer than the recent evidence of adult studies showing that 5 days can be enough in several bacterial infections, from hospital to community-acquired pneumonia [ 10 ].…”