Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign
Articolo
Data di Pubblicazione:
2018
Citazione:
Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign / L. Furlan, L. Erba, L. Trombetta, R. Sacco, G. Colombo, G. Casazza, M. Solbiati, N. Montano, C. Marta, R. Sbrojavacca, F. Perticone, G.R. Corazza, G. Costantino. - In: INTERNAL AND EMERGENCY MEDICINE. - ISSN 1828-0447. - (2018 Oct 08). [Epub ahead of print]
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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Antibiotic treatment; Choosing wisely; Guidelines; Infection; Pneumonia; Systematic review; Internal Medicine; Emergency Medicine
Elenco autori:
L. Furlan, L. Erba, L. Trombetta, R. Sacco, G. Colombo, G. Casazza, M. Solbiati, N. Montano, C. Marta, R. Sbrojavacca, F. Perticone, G.R. Corazza, G. Costantino
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