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Efficacy of 3-day versus 5-day antibiotic therapy for clinically diagnosed nonsevere pneumonia in children from developing countries

Sutijono, Darrella; Hom, Jeffreyb; Zehtabchi, Shahriarc

European Journal of Emergency Medicine: October 2011 - Volume 18 - Issue 5 - p 244–250
doi: 10.1097/MEJ.0b013e328344fd90

Pneumonia is the leading cause of mortality in young children in developing countries. A short course of antibiotics in the treatment of nonsevere pneumonia has been suggested as feasible and could lead to decreased costs, risk of adverse events, and development of antimicrobial resistance. This review evaluates the evidence regarding the duration of antibiotic treatment in this population. The PubMed, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they enrolled patients in developing countries between the ages of 2 months to 18 years clinically diagnosed with nonsevere pneumonia, and compared the clinical outcomes of a short course of oral antibiotics with a long course. The outcomes of interest included failure rate, relapse rate, and safety. Four randomized controlled trials were identified, which enrolled 9235 patients cumulatively. All patients were aged between 2 to 59 months and diagnosed using World Health Organization defined criteria. All four trials showed no significant difference in relapse rates between 3-day and 5-day courses. In one study, the 3-day course was associated with higher rates of treatment failure and adverse events, with no adverse event classified as severe. Overall, short and long courses of antibiotics produce similar outcomes treating clinically diagnosed, nonsevere pneumonia in children in developing countries between the ages of 2 to 59 months. Three out of four studies in this review, representing two-thirds of the patients in aggregate, showed no significant difference in treatment failure or relapse rates between a 3-day and 5-day course of antibiotics.

aDepartment of Emergency Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California

bDepartment of Emergency Medicine, Department of Pediatrics/Emergency Services, New York University, New York

cDepartment of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center, Brooklyn, New York, USA

Correspondence to Darrell Sutijono, MD, Department of Emergency Medicine, Kaiser Permanente Santa Clara Medical Center, 700 Lawrence Expressway, Santa Clara, CA 95051, USA Tel: +1 408 851 5443; fax: +1 408 851 5441; e-mail:

Received August 25, 2010

Accepted January 25, 2011

© 2011 Lippincott Williams & Wilkins, Inc.