Short-course versus standard- or longer-course oral antibiotic therapy for pneumonia and lower respiratory tract infection in children: a systematic review and meta-analysis of randomized controlled trials
4 affiliations
- 1Emergency and Critical Care Medicine Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology
- 2Outpatient Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology
- 3The First School of Clinical Medicine, Nanjing Medical University
- 4Outpatient Office, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology
Abstract
Background: Reducing unnecessary antibiotic exposure is a major priority in pediatric antimicrobial stewardship. The comparative effectiveness of short-course versus standard- or longer-course oral antibiotic therapy for uncomplicated bacterial infections in children remains uncertain.
Objective: To evaluate whether short-course oral antibiotic therapy increases clinical treatment failure compared with standard- or longer-course therapy in children with uncomplicated bacterial infections, with a primary focus on same-antibiotic pediatric pneumonia/lower respiratory tract infection (LRTI) trials.
Methods: We conducted a systematic review and meta-analysis of randomized controlled trials. MEDLINE/PubMed, Embase, Web of Science, and CENTRAL were searched, supplemented by citation searching and trial registry review. Eligible studies enrolled children aged 0–18 years with uncomplicated bacterial infections treated with oral antibiotics in outpatient or ambulatory settings. The primary outcome was clinical treatment failure; broader pneumonia/LRTI and all-infection analyses were treated as sensitivity or exploratory analyses. Random-effects meta-analysis used risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs). Risk of bias was assessed with the Cochrane risk-of-bias tool. The review was registered in PROSPERO (CRD420261339263).
Results: Fourteen randomized trials were included; nine same-antibiotic pneumonia/LRTI comparisons contributed to the primary pooled analysis. Short-course therapy was not associated with increased treatment failure (RR, 1.01; 95% CI, 0.92–1.11; I ² = 0.0%), and the absolute-effect analysis showed no meaningful difference (RD, 0.001; 95% CI, −0.010 to 0.013; I ² = 10.0%). A broad pneumonia/LRTI sensitivity analysis including different-antibiotic comparisons was also non-significant (RR, 0.94; 95% CI, 0.66–1.33) but heterogeneous. The all-infection exploratory analysis was similarly non-significant (RR, 0.89; 95% CI, 0.63–1.25) and interpreted cautiously given clinical heterogeneity. Of the 14 trials, 5 were at low risk of bias, 2 had some concerns, and 7 were at high risk.
Conclusion: In same-antibiotic pediatric pneumonia/LRTI trials, short-course therapy was not associated with increased clinical treatment failure compared with standard- or longer-course therapy. Broader analyses across different antibiotic strategies and infection syndromes did not materially change this interpretation but showed substantial heterogeneity. These findings support cautious, infection-specific antibiotic duration reduction rather than broad generalization across all uncomplicated pediatric bacterial infections.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261339263 , identifier CRD420261339263.
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BibTeX
@article{zhou2026shortcourse,
title = {{Short-course versus standard- or longer-course oral antibiotic therapy for pneumonia and lower respiratory tract infection in children: a systematic review and meta-analysis of randomized controlled trials}},
author = {Lian Zhou and Shanshan Wang and Yuyi Tang and Jinlin Chen and Xingfeng Cheng},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1877367},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1877367/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Short-course versus standard- or longer-course oral antibiotic therapy for pneumonia and lower respiratory tract infection in children: a systematic review and meta-analysis of randomized controlled trials
AU - Lian Zhou
AU - Shanshan Wang
AU - Yuyi Tang
AU - Jinlin Chen
AU - Xingfeng Cheng
PY - 2026
DA - 2026/10/14
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1877367
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1877367/full
AB - Background: Reducing unnecessary antibiotic exposure is a major priority in pediatric antimicrobial stewardship. The comparative effectiveness of short-course versus standard- or longer-course oral antibiotic therapy for uncomplicated bacterial infections in children remains uncertain. Objective: To evaluate whether short-course oral antibiotic therapy increases clinical treatment failure compared with standard- or longer-course therapy in children with uncomplicated bacterial infections, with a primary focus on same-antibiotic pediatric pneumonia/lower respiratory tract infection (LRTI) trials. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials. MEDLINE/PubMed, Embase, Web of Science, and CENTRAL were searched, supplemented by citation searching and trial registry review. Eligible studies enrolled children aged 0–18 years with uncomplicated bacterial infections treated with oral antibiotics in outpatient or ambulatory settings. The primary outcome was clinical treatment failure; broader pneumonia/LRTI and all-infection analyses were treated as sensitivity or exploratory analyses. Random-effects meta-analysis used risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs). Risk of bias was assessed with the Cochrane risk-of-bias tool. The review was registered in PROSPERO (CRD420261339263). Results: Fourteen randomized trials were included; nine same-antibiotic pneumonia/LRTI comparisons contributed to the primary pooled analysis. Short-course therapy was not associated with increased treatment failure (RR, 1.01; 95% CI, 0.92–1.11; I ² = 0.0%), and the absolute-effect analysis showed no meaningful difference (RD, 0.001; 95% CI, −0.010 to 0.013; I ² = 10.0%). A broad pneumonia/LRTI sensitivity analysis including different-antibiotic comparisons was also non-significant (RR, 0.94; 95% CI, 0.66–1.33) but heterogeneous. The all-infection exploratory analysis was similarly non-significant (RR, 0.89; 95% CI, 0.63–1.25) and interpreted cautiously given clinical heterogeneity. Of the 14 trials, 5 were at low risk of bias, 2 had some concerns, and 7 were at high risk. Conclusion: In same-antibiotic pediatric pneumonia/LRTI trials, short-course therapy was not associated with increased clinical treatment failure compared with standard- or longer-course therapy. Broader analyses across different antibiotic strategies and infection syndromes did not materially change this interpretation but showed substantial heterogeneity. These findings support cautious, infection-specific antibiotic duration reduction rather than broad generalization across all uncomplicated pediatric bacterial infections. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261339263 , identifier CRD420261339263.
SN - 1663-9812
ER -