Bottom Line

A five-day course of antibiotics was statistically inferior to the traditional 10-day course for children with CAP treated as outpatients, but it is unclear if this is clinically important.

Case Resolution

You engage in shared decision making with the parents and ask them if they would like a short course of antibiotics (five days) or the traditional course (10 days). Both have about a 90 percent chance of success, but a few more children were not clinically cured after five days of treatment.

Thank you to Dr. Andrew Tagg, who is an emergency physician and co-founder and website lead for Don’t Forget the Bubbles (https://dontforgetthebubbles.com), for his help with this review.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine. 

References

1. Rudan I, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86(5):408-416.
2. Pneumonia fact sheet No. 331. World Health Organization website. Accessed July 29, 2021.
3. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76.
4. Greenberg D, Givon-Lavi N, Sadaka Y, et al. Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: a double-blind, randomized, placebo-controlled trial. Pediatr Infect Dis J. 2014;33(2):136-142.
5. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.