Careful antibiotic stewardship with judicious use of antibiotics should make a difference to the challenge of antibiotic resistance. The Archivist was trained that 10 days of antibiotics and initial intravenous route was standard treatment for a community acquired pneumonia (CAP) in an immunocompetent child. This appears to continue to be standard treatment in many countries with some guidelines still recommending that length of course. The evidence has been building up for shorter courses and lower doses. Li Q et al JAMA Pediatr. doi:10.1001/ jamapediatrics.2022.4123 has published a systematic review with meta analysis examining nine randomised clinical trials (RCTs) from 1999 onwards but four of them from the last 2 years including 11143 children with almost all under the age of 5 years and no neonates, with nonsevere CAP. Treatment failure, although with slightly different definitions, was the primary outcome and the margin for non-inferiority was 5 difference. Eight RCTs included treatment failure as their primary outcome. The bottom line was that treatment failure occurred in 12.8 vs 12.6 of those randomised to a shorter vs a longer course of antibiotics (risk ratio, 1.01; 95CI, 0.92 to 1.11; risk difference, 0.00; 95CI, -0.01 to 0.01; I~2 = 0).
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