ORIGINAL ARTICLES

Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children

D E Karageorgopoulos¹, P E Valkimadi¹, A Kapaskelis^1,2, P I Rafailidis^1,2, M E Falagas^1,2,3

¹ Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
² Department of Medicine, Henry Dunant Hospital, Athens, Greece
³ Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA

Correspondence to:
Dr M E Falagas, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece; m.falagas{at}aibs.gr

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).

Review 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.

Conclusion: 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.

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