From the Guidelines
Optimal Duration of Antibiotics in Pediatric Bacteremia
The optimal duration of antibiotics in pediatric bacteremia is short-course therapy, typically ranging from 3 to 5 days, as it has been shown to be as effective as long-course therapy in several studies 1.
Key Findings
- A study published in 2023 found that short-course antibiotics (3-5 days) were as effective as long-course antibiotics (5-14 days) in treating community-acquired pneumonia (CAP) in children, with no difference in treatment failure, clinical cure, or need for re-treatment 1.
- Another study published in 2023 supported the use of short-duration antibiotic therapy for CAP, particularly when coupled with clinical stability, and found that short courses (≤ 6 days) were as effective as long courses, with fewer serious adverse events and low mortality 1.
- The evidence suggests that short-course therapy can be used to treat pediatric bacteremia, including CAP, without compromising efficacy or increasing the risk of treatment failure or antimicrobial resistance.
Relevant Studies
- A meta-analysis of 21 studies, including RCTs and observational studies, concluded that short courses (≤ 6 days) were as effective as long courses, with fewer serious adverse events and low mortality 1.
- Six recent RCTs published on CAP duration, five in children and one in adults, found that short-duration courses were non-inferior to long-duration courses 1.
Clinical Implications
- Short-course therapy (3-5 days) can be considered as a viable treatment option for pediatric bacteremia, including CAP, in clinically stable patients.
- Clinicians should consider the potential benefits of short-course therapy, including reduced risk of antimicrobial resistance and adverse events, when making treatment decisions for pediatric patients with bacteremia.
From the Research
Optimal Duration of Antibiotics in Pediatric Bacteremia
- The optimal duration of antibiotic therapy for pediatric bacteremia remains undefined, with various studies suggesting different durations 2, 3, 4, 5.
- A retrospective cohort study found that a prolonged duration of antibiotic therapy did not reduce the relapse risk compared with shorter durations in children with uncomplicated Gram-negative bacteraemia 2.
- A systematic review and meta-analysis found that short-course antibiotic treatment was non-inferior to long-course treatment in patients with uncomplicated gram-negative bacteremia, with no significant difference in 30-day mortality, recurrent bacteremia, or adverse events 3.
- A retrospective observational study found that shorter courses of IV antibiotics (<7 days) were non-inferior to longer courses in healthy children with nontyphoidal Salmonella bacteremia, with reduced hospital stay and no association between IV treatment duration and risk of relapse 4.
- Another study found that changes in the etiology of pediatric bacteremia have implications for prompt, appropriate empirical treatment, with increasing healthcare-associated bacteremia and reduced susceptibility to empirical antibiotics 6.
- A systematic review and meta-analysis found that among bacteremic patients receiving shorter (5-7 days) versus longer (7-21 days) antibiotic therapy, no significant difference was detected with respect to rates of clinical cure, microbiologic cure, and survival 5.
Key Findings
- Shorter durations of antibiotic therapy may be as effective as longer durations for pediatric bacteremia 2, 3, 4, 5.
- The risk of relapse and mortality does not appear to be reduced with longer durations of antibiotic therapy 2, 3, 5.
- Healthcare-associated bacteremia is increasing, and prompt, effective antimicrobial administration requires new tools to improve recognition and continued etiological surveillance 6.
- Further studies are needed to confirm the findings and determine the optimal duration of antibiotic therapy for pediatric bacteremia 2, 3, 4, 5.