G2-1286. Short Versus Long Duration Antibiotic Therapy for Bacterial Meningitis: A Meta-aAnalysis of Randomized Controlled Trials
Session: Poster Session: Pediatrics I
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Recommendations on the duration of treatment of bacterial meningitis are primarily based on clinical experience. We sought to evaluate the effectiveness and safety of short duration of treatment for bacterial meningitis, by performing a meta-analysis of randomized controlled trials (RCTs). We searched PubMed, and the Cochrane Central Register of Controlled Trials. Methods: We searched for RCTs performed on patients of all ages with community-acquired bacterial meningitis, comparing treatment with the same antibiotics, in the same daily dosage, for a short course (4-7 days) versus a longer course (2 or more additional days).
Results: Five open-label RCTs, involving children (3 weeks to 16 years-old), were included. No difference was found between short-course (4-7 days) and long-course (7-14 days) treatment (i.v. ceftriaxone) regarding end-of-therapy clinical success (5 RCTs, 383 patients, fixed effect model (FEM), odds ratio (OR)=1.24, 95% confidence interval (CI)[0.73, 2.11]); long-term neurological complications (5 RCTs, 367 patients, FEM, OR=0.60, 95% CI[0.29, 1.27]); long-term hearing impairment (4 RCTs, 241 patients, FEM, OR=0.59, 95% CI[0.28, 1.23]); total adverse events (2 RCTs, 122 patients, FEM, OR=1.29, 95% CI[0.57, 2.91]); or secondary nosocomial infections (2 RCTs, 139 patients, random effects model, OR=0.45, 95% CI[0.05, 3.71]). The duration of hospitalization was lower with short-course treatment (2 RCTs, 137 patients, FEM, weighted mean difference=-2.17 days, 95% CI[-3.85, -0.50]) Conclusion: The effectiveness and safety of short-course antibiotic treatment for children with bacterial meningitis was not found inferior to long-course treatment. Due to scarcity of available evidence, further research on this issue is suggested.
Anastasios Kapaskelis, MD1, Drosos Karageorgopoulos, MD2, Matthew Falagas, MD, MSc, DSc2, Petros Rafailidis, MD, MSc, MRCP UK2, Politimi Eleni Valkimadi, MD2 and  M. E. Falagas, None., (1)Alfa HealthCare and “Henry Dunant” Hospital, Marousi, Greece, (2)Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece


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