From the Guidelines
Shortening antibiotic duration in pediatric patients is generally recommended when appropriate, with most common infections requiring 5-7 days of treatment. For community-acquired pneumonia (CAP), a study published in 2022 [@8@] found that a 5-day course of oral beta-lactam antibiotics was superior to a 10-day course, with a 69% probability of a more desirable response adjusted for duration of antibiotic risk. This is consistent with other studies, such as one published in 2020 [@10@], which found no difference in treatment failure between 3-day and 5-day courses of amoxicillin for children with chest-indrawing pneumonia.
Key considerations for shortening antibiotic courses in pediatrics include:
- Accurate diagnosis and appropriate antibiotic selection
- Patient adherence to the full prescribed course
- Follow-up to confirm resolution of symptoms
- Individual patient's clinical response and adjustment of treatment as necessary
Specific recommendations for common pediatric infections include:
- Community-acquired pneumonia: 5 days of amoxicillin (90 mg/kg/day in 2 divided doses) [@8@]
- Uncomplicated urinary tract infection: 3-5 days of trimethoprim-sulfamethoxazole (8 mg/kg/day of trimethoprim component in 2 divided doses)
- Acute otitis media and streptococcal pharyngitis: 5-7 days of amoxicillin (80-90 mg/kg/day in 2 divided doses for otitis media and 50 mg/kg/day in 2 divided doses for pharyngitis)
Shorter antibiotic courses can reduce the risk of antibiotic resistance, minimize side effects, improve compliance, and decrease healthcare costs 1. However, some conditions, such as osteomyelitis and endocarditis, may still require longer treatment durations. It is essential to consider the individual patient's clinical response and adjust treatment as necessary.
From the FDA Drug Label
Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever
The duration of antibiotics in pediatrics can be at least 48 to 72 hours beyond the time the patient becomes asymptomatic, or until evidence of bacterial eradication is obtained. Additionally, for infections caused by Streptococcus pyogenes, treatment should be continued for at least 10 days to prevent acute rheumatic fever 2.
From the Research
Antibiotic Duration in Pediatrics
- The duration of antibiotic treatment in pediatrics can be optimized to minimize the risk of antibiotic resistance and reduce unnecessary antibiotic use 3, 4.
- Studies have shown that less than one-third of antibiotics prescribed to pediatric outpatients are optimal for choice and duration, highlighting the need for improved antibiotic stewardship 5.
- In hospitalized pediatric patients, pharmacists play a key role in evaluating and creating antibiotic treatment plans, and can help optimize antibiotic selection, dosing, and monitoring 6.
Shortening Antibiotic Duration
- Research suggests that durations of intravenous antibiotic therapy for bacterial infections in hospitalized children can be shortened, and that fixed durations are not always necessary 7.
- A framework for determining the duration of antibiotic therapy has been proposed, taking into account patient-centered factors such as severity of infection, response to therapy, and family preferences 7.
- Shortening antibiotic duration can help reduce the risk of antibiotic resistance, minimize harms and costs, and improve patient outcomes 3, 4, 5, 7.
Specific Infections
- For certain infections, such as community-acquired pneumonia, shorter antibiotic treatment courses may be effective, with only 5.7% of antibiotics prescribed for this condition having a 5-day duration 5.
- Acute otitis media and pharyngitis are common indications for antibiotic use in pediatrics, and optimal antibiotic choice and duration can be achieved through improved prescribing practices 5.