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Shorter versus longer duration of antibiotic treatment in children with bacterial meningitis: a systematic review and meta-analysis

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Abstract

The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I2 statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up.

  Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843).

What is Known:

• Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice.

• Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects.

What is New:

• There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.

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Data availability

Because this meta-analysis was based on data extracted from previously published research, all the data and study materials are available in the public domain. The authors do not have access to patient-level data of the individual studies. Researchers with an interest in individual-level data from the studies included in this meta-analysis are encouraged to contact the corresponding author from each study for such requests.

Abbreviations

AAP:

American Academy of Pediatrics

CI:

Confidence Interval

CPS:

Canadian Paediatric Society

CSF:

Cerebrospinal Fluid

GRADE:

Grading of Recommendations, Assessment, Development and Evaluation

IDSA:

Infectious Diseases Society of America

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

RCT:

Randomized Controlled Trial

RoB-2:

Cochrane’s Risk of Bias 2 software

RR:

Risk Ratio

WHO:

World Health Organization

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Medicine, Federal University of Grande Dourados, Dourados, MS, Brazil

    Renan Yuji Ura Sudo

  2. Division of Medicine, Federal University of Goiás, Goiânia, GO, Brazil

    Maria Carrijo Cunha Câmara

  3. Division of Medicine, University of Vale do Rio dos Sinos, São Leopoldo, RJ, Brazil

    Sofia Vezzani Kieling

  4. Division of Medicine, Universitat Internacional de Catalunya, Barcelona, CAT, Spain

    Isabela Reis Marques

  5. Division of Medicine, Federal University of Rio de Janeiro, Macaé, RJ, Brazil

    Yasmin Mesquita

  6. Division of Internal Medicine, Primary Care, University of Connecticut, Farmington, CT, USA

    Blake Earl Piepenbrink

  7. Pediatric Division, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Paula Chaves Mari

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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Maria Carrijo Cunha Camara, Renan Yuji Ura Sudo and Sofia Vezzani Kieling. The first draft of the manuscript was written by Renan Yuji Ura Sudo, Maria Carrijo Cunha Camara, Sofia Vezzani Kieling, Isabela Reis Marques, and Yasmin Luz Lima de Mesquita. All authors critically reviewed previous versions of the manuscript. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to Renan Yuji Ura Sudo.

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Sudo, R.Y.U., Câmara, M.C.C., Kieling, S.V. et al. Shorter versus longer duration of antibiotic treatment in children with bacterial meningitis: a systematic review and meta-analysis. Eur J Pediatr 183, 61–71 (2024). https://doi.org/10.1007/s00431-023-05275-8

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