SynthesisBMJ open2023
Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis.
Synthesis in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- European stroke organisation guideline on stroke-associated pneumonia.European stroke journal · 2026Guideline
- Article
- Community pharmacists and outpatient antimicrobial stewardship: evidence, uncertainties, and future directions.Frontiers in health services · 2026Article
- Expanding AMR surveillance with the WHO's AWaRe classification: a nationwide occupational cohort study in Taiwan (2004-2020).BMJ public health · 2026Article
- The role of the community pharmacist in antibiotic use - a commentary on current status and future perspectives.Exploratory research in clinical and social pharmacy · 2025Article
- Optimal antibiotic use in the intensive care unit.Critical care (London, England) · 2025Review
- Emergency planned re-infusion therapy and hospitalisation for community-acquired pneumonia: a retrospective case-control study.Journal of global health · 2025Article
- Impact of order set implementation on appropriate treatment of community-acquired pneumonia (CAP).Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review.Antibiotics (Basel, Switzerland) · 2024Review
- Necrotizing Pneumonia: A Practical Guide for the Clinician.Pathogens (Basel, Switzerland) · 2024Review
- Antibiotic-Induced Immunosuppression-A Focus on Cellular Immunity.Antibiotics (Basel, Switzerland) · 2024Review
- Controversies in the management of community-acquired pneumonia in adults.Australian prescriber · 2024Review
- Shorter and Longer Antibiotic Durations for Respiratory Infections: To Fight Antimicrobial Resistance-A Retrospective Cross-Sectional Study in a Secondary Care Setting in the UK.Pharmaceuticals (Basel, Switzerland) · 2024Article
- Diagnostic and Prognostic Roles of Procalcitonin and Other Tools in Community-Acquired Pneumonia: A Narrative Review.Diagnostics (Basel, Switzerland) · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo find the optimal treatment duration with antibiotics for community-acquired pneumonia (CAP) in adults.
designSystematic review and duration-effect meta-analysis. DATA SOURCES: MEDLINE, Embase and CENTRAL through 25 August 2021. ELIGIBILITY CRITERIA: All randomised controlled trials comparing the same antibiotics used at the same daily dosage but for different durations for CAP in adults. Both outpatients and inpatients were included but not those admitted to intensive care units. We imposed no date, language or publication status restriction. DATA EXTRACTION AND SYNTHESIS: Data extraction by two independent reviewers. We conducted a random-effects, one-stage duration-effect meta-analysis with restricted cubic splines. We tested the non-inferiority with the prespecified non-inferiority margin of 10% examined against 10 days . The primary outcome was clinical improvement on day 15 (range 7-45 days). SECONDARY OUTCOMES: all-cause mortality, serious adverse events and clinical improvement on day 30 (15-60 days).
resultsWe included nine trials (2399 patients with a mean (SD) age of 61.2 (22.1); 39% women). The duration-effect curve was monotonic with longer duration leading to a lower probability of improvement, and shorter treatment duration (3-9 days) was likely to be non-inferior to 10-day treatment. Harmful outcome curves indicated no association. The weighted average percentage of the primary outcome in the 10-day treatment arms was 68%. Using that average, the absolute clinical improvement rates of the following durations were: 3-day treatment 75% (95% CI: 68% to 81%), 5-day treatment 72% (95% CI: 66% to 78%) and 7-day treatment 69% (95% CI: 61% to 76%).
conclusionsShorter treatment duration (3-5 days) probably offers the optimal balance between efficacy and treatment burden for treating CAP in adults if they achieved clinical stability. However, the small number of included studies and the overall moderate-to-high risk of bias may compromise the certainty of the results. Further research on the shorter duration range is required. PROSPERO REGISTRATION NUMBER: CRD 42021273357.
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