Optimal Antibiotic Treatment Duration of Upper and Lower Respiratory Tract Infections

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The available evidence for non-ICU community-acquired pneumonia (CAP) and chronic obstructive pulmonary disease (AECOPD) supports a short-course treatment duration of 5 days in patients who have clinically improved.

Efforts of the scientific community should be directed at implementing this evidence in daily practice.

High-quality RCTs are needed to underpin even shorter treatment durations for CAP and AECOPD, to establish the optimal treatment duration of HAP and acute sinusitis, and to evaluate shorter duration using an optimal penicillin dosing schedule in patients with pharyngotonsillitis.

We identified 30 systematic reviews meeting the criteria; they were generally of a low to critically low quality.

21 reviews conducted a meta-analysis. For CAP outside the intensive care unit (ICU; 14 reviews, of which eight did a meta-analysis) and AECOPD (eight reviews, of which five did a meta-analysis), there was sufficient evidence supporting a treatment duration of 5 days; evidence for shorter durations is scarce.

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