Five-day antibiotic treatment for community-acquired bacterial pneumonia: A systematic review and meta-analysis of randomized controlled trials

J Glob Antimicrob Resist. 2020 Dec:23:94-99. doi: 10.1016/j.jgar.2020.08.005. Epub 2020 Aug 28.


Objectives: This systematic review and meta-analysis of randomized controlled trials (RCTs) investigated whether the clinical efficacy of a 5-day antibiotic course is comparable to that of a longer (≥7 d) course for treating adults with community-acquired bacterial pneumonia (CABP).

Methods: The PubMed, Web of Science, Cochrane Library, Ovid MEDLINE, and Embase. were searched before January 18, 2020. RCTs comparing the efficacy of a 5-day antibiotic course with a longer course (≥7 d) for CABP treatment were included. Primary outcomes included the clinical response, microbiological response, and risk of adverse events (AEs).

Results: In this meta-analysis, 7 RCTs were included, and the 5-day antibiotic courses group, and a longer course group comprised 1499 and 1522 patients, respectively. The difference in the overall clinical response rates between the 5-day and longer courses (88.3% vs 88.8%, odds ratio [OR], 0.95, 95% confidence interval [CI], 0.70-1.28, I2 = 19%) was nonsignificant. Additionally, the microbiological eradication rates did not differ significantly between the groups, at 94.8% and 95.8% in the 5-day and longer courses groups, respectively (OR, 0.84, 95% CI, 0.38-1.87, I2 = 0%). Finally, all-cause mortality did not differ between the 2 groups (OR, 0.91, 95% CI, 0.31-2.66, I2 = 0%).

Conclusions: Five-day treatment and longer antibiotic courses for CABP yield similar clinical and microbiological responses and exhibit similar safety profiles.

Keywords: Antibiotic; Bacterial Pneumonia; Community-acquired; Outcome; Short course.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Anti-Bacterial Agents / adverse effects
  • Community-Acquired Infections* / drug therapy
  • Humans
  • Pneumonia, Bacterial* / drug therapy
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Anti-Bacterial Agents