Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children.
OBJECTIVE
To evaluate the effectiveness and safety of short-course antibiotic therapy for bacterial meningitis, by performing a meta-analysis of randomised controlled trials (RCT).


METHODS
PubMed and the Cochrane Central Register of Controlled Trials were searched for RCT on patients of all ages with community-acquired acute bacterial meningitis that compared treatment with the same antibiotics, in the same daily dosage, administered for a short course (up to 7 days) versus a longer course (2 days or more than corresponding short course).


RESULTS
Five open-label RCT involving children (3 weeks to 16 years) were included. No difference was demonstrated between short-course (4-7 days) and long-course (7-14 days) treatment (intravenous ceftriaxone) regarding: end-of-therapy clinical success (five RCT, 383 patients, fixed effect model (FEM), odds ratio (OR) 1.24, 95% CI 0.73 to 2.11); long-term neurological complications (five RCT, 367 patients, FEM, OR 0.60, 95% CI 0.29 to 1.27); long-term hearing impairment (four RCT, 241 patients, FEM, OR 0.59, 95% CI 0.28 to 1.23); total adverse events (two RCT, 122 patients, FEM, OR 1.29, 95% CI 0.57 to 2.91); or secondary nosocomial infections (two RCT, 139 patients, random effects model, OR 0.45, 95% CI 0.05 to 3.71). The duration of hospitalisation was lower with short-course treatment (two RCT, 137 patients, FEM, weighted mean difference -2.17 days, 95% CI -3.85 to -0.50). The available data did not allow for analysis by causative organism.


CONCLUSIONS
This meta-analysis of the rather limited available relevant data could not show differences between short and long-course antibiotic treatment for bacterial meningitis in children. Further research on this issue is required.
Karageorgopoulos
D E
DE
Alfa Institute of Biomedical Sciences (AIBS), 151 23 Marousi, Athens, Greece.
Valkimadi
P E
PE
Kapaskelis
A
A
Rafailidis
P I
PI
Falagas
M E
ME
D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000382:microbiology; D034381:Hearing Loss / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone