SR: Short courses of antibiotics as effective as longer courses for outpatient infections

Are short courses of antibiotics as effective as longer courses for common outpatient infections?

Just about every time someone asks "Can I get away with a shorter course of antibiotics," the answer is "Yes, you can." Shorter courses reduce cost, and may reduce the likelihood of adverse events. (LOE = 1a)

Dawson-Hahn EE, Mickan S, Onakpoya I, et al. Short-course versus long-course oral antibiotic treatment for infections treated in outpatient settings: a review of systematic reviews. Fam Pract 2017;34(5):511-519.  [PMID:28486675]

Meta-analysis (randomized controlled trials)

Government

Various (meta-analysis)

This is a relatively new kind of study: a systematic review of systematic reviews, also called a systematic overview. The authors searched 5 databases and identified 9 systematic reviews that compared the duration of antibiotic therapies for a common outpatient infection. The reviews included between 2 studies and 17 studies, with a total of between 395 and 5763 patients. The best studied conditions were urinary tract infection (UTI), sinusitis, and community-acquired pneumonia (CAP). The authors found that, in children, 5 to 7 days was as good as 10 days for strep pharyngitis; 3 days was as good as 5 days for CAP; more than 2 days was as good as 7 or more days for otitis media, and 2 to 4 days was as good as 7 to 14 days for UTI. In adults, 3 to 7 days was as good as 6 to 10 days for acute bacterial sinusitis, 3 days was as good as 5 or more days for uncomplicated UTI in nonpregnant women, and 7 to 14 days was as good as 14 to 42 days for acute pyelonephritis. The authors also found that 7 or fewer days was as good as more than 7 days for CAP, and 3 to 6 days was as effective as 7 to 14 days for UTI in older women. There was some evidence that shorter courses resulted in fewer adverse events when treating acute otitis media in children and acute sinusitis in adults.