On behalf of IQWiG, a scientific team led by the University of Freiburg has investigated whether shorter-duration antibiotic therapy yields treatment results that are comparable to longer-duration treatment. The following picture emerges for the two diseases specifically investigated in the ThemenCheck report:
It remains unclear whether children and adolescents with acute otitis media benefit from shorter-duration antibiotic therapy. Further good studies are needed for amoxicillin, the antibiotic of first choice.
In children with community-acquired pneumonia, the therapeutic success of shorter-duration antibiotic therapy is comparable to that of a usual treatment duration. However, there is a lack of corresponding studies for adults and adolescents with this disease. "The study situation in children shows that such studies are urgently needed and are also feasible" underlines Corinna Schaefer, head of IQWiG's Health Care and Guidelines department. "As in view of increasing resistance it is important to use antibiotics consciously and as sparingly as possible".
Is shorter better to avoid resistance?
Antibiotics are used to treat bacterial infections. They alleviate the symptoms of the disease and speed up recovery by inhibiting bacterial growth or killing bacteria.
The use of antibiotics is always associated with the risk of resistance developing. In order to reduce this risk , many physicians practising infectious disease medicine assumed that sufficiently long treatment was necessary - even if the patient's symptoms had already subsided. However, many scientists now also advocate the "shorter is better" approach.
In this context, a member of the public asked IQWiG as part of the ThemenCheck Medizin whether shorter compared to (the usual) longer-duration antibiotic treatment yields comparable treatment results.
Further studies are required
Against this background, this ThemenCheck report investigated the comparison of shorter-duration antibiotic therapy with longer-duration antibiotic therapy for the bacterial infectious diseases acute otitis media in children and community-acquired pneumonia in children and adults.
For acute otitis media, the team identified twelve suitable studies that investigated seven different antibiotics approved in Germany (e.g. penicillin or amoxicillin) with regard to the effects of different treatment durations in children aged between one month and 14 years. Their conclusion after analysing these studies: There is no hint of non-inferiority of the shorter-duration treatment for any of the antibiotics investigated, either for the outcome treatment success or for the outcomes recurrence of the infection, adverse events or mortality. However, this does not mean that shorter-duration therapy is inferior, but only that it cannot be confirmed with certainty whether it is equivalent.
Seven studies investigated the duration of amoxicillin treatment for community-acquired pneumonia in children. The mean age of the children included was 1 to 2 years in most studies, with the maximum age limit for study inclusion ranging from 5 to 10 years in most studies. The included studies investigated five different comparisons of shorter with longer-duration antibiotic treatment (e.g. three vs. five days or five vs. ten days).
The results for this therapeutic indication: In children with community-acquired pneumonia, shorter-duration treatment yielded a therapeutic success comparable to that of longer-duration antibiotic treatment. Children had fewer side effects with three-day treatment, e.g. gastrointestinal infections, than children after five days of treatment. There was no hint of non-inferiority of shorter-duration antibiotic therapy for the outcomes recurrence and mortality.
There is a lack of studies comparing shorter-duration antibiotic therapy with a conventional duration for adults and adolescents with community-acquired pneumonia.
Summarized conclusion from IQWiG's perspective
A general conclusion about shorter-duration antibiotic treatment is currently not possible. There is also no uniform picture for the diseases investigated in the ThemenCheck report (acute otitis media and community-acquired pneumonia).
Against the background of these uncertain results, the choice of a treatment regimen - for example in acute otitis media - requires a joint decision-making process in which not only individual (e.g. adverse effects, treatment adherence, treatment success), but public health aspects can also play a role:
Shorter-duration antibiotic therapy is ecologically sound and resource-efficient as well as ethically, legally and socially acceptable. In particular the principle of antibiotic stewardship, which aims to minimize the risk of resistance, could be an argument in favour of shorter-duration treatment.
At the same time, questions remain unanswered: What is the optimal treatment duration for other antibiotics, age groups and therapeutic indications from the perspective of benefit assessment and health economic evaluation? Which (shorter-duration) antibiotic therapy is most suitable? With regard to this last question, the ongoing study from Australia identified in the ThemenCheck report, which compares treatment with amoxicillin over 2, 3, 4 and 5 days in children with community-acquired pneumonia, could provide results and insights.
ThemenCheck Medizin
Interested parties can submit proposals for the assessment of medical interventions and technologies as part of ThemenCheck Medizin. In a two-stage selection process, which also involves members of the public, up to five new topics of particular importance to patient care are selected from the proposals submitted each year. The ThemenCheck reports are not written by IQWiG itself, but by external experts. Their assessment is published together with a generally understandable executive summary and a publisher's comment by IQWiG.
The Institute published the preliminary findings of the report "Antibiotic therapy: Does shorter-duration treatment yield comparable treatment results?" as a preliminary ThemenCheck report in January 2025 and put it up for discussion. After the end of the commenting procedure, the report was revised and has now been published in its final version.
