Efficacy, Safety, and Long-Term Outcomes of Shorter (≤ 4 Weeks) Versus Longer (> 4 Weeks) Antibiotic Therapy in Pediatric Empyema Thoracis: A Systematic Review.

CONTEXT: Although antibiotics remain the cornerstone of empyema thoracis management, the optimal duration of therapy in children remains uncertain. Prolonged antibiotic courses are frequently used despite limited evidence supporting their necessity; potentially increasing healthcare costs, medication-related adverse effects, and the risk of antimicrobial resistance.

OBJECTIVE

To evaluate the available evidence on the efficacy, safety, and clinical outcomes of shorter (≤ 4 weeks) versus longer (> 4 weeks) total antibiotic treatment durations (from initiation to cessation) in children with empyema, with the aim of informing evidence-based guidance.

EVIDENCE ACQUISITION: A systematic search of PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, ProQuest, OpenGrey, and four major clinical trial registries was conducted. Randomized controlled trials enrolling children (< 18 years) with empyema defined by standard criteria, and comparing different durations of antibiotic therapy were eligible. Outcomes of interest included resolution of disease, relapse, need for additional interventions, re-hospitalization, adverse events, long-term clinical outcomes, and cost. All key steps of the review were undertaken by two reviewers working independently.

RESULTS

The search yielded 20,353 records. After excluding 5497 duplicate citations, 14,856 unique citations were screened using a three-step process. A total of 18 citations were short-listed for full-text examination. However, there were no randomized controlled trials fulfilling the eligibility criteria. Although several observational studies were identified, these were ineligible for inclusion.

CONCLUSION

The optimal duration of antibiotic therapy for children with empyema thoracis remains uncertain, due to paucity of randomized controlled trials comparing shorter versus longer treatment courses.