Comparative Effectiveness of Short-Course Versus Standard-Course Empiric Antibiotic Therapy for Acute Bacterial Meningitis: A Systematic Review.

Acute bacterial meningitis (ABM) remains a significant cause of mortality and long-term neurodevelopmental morbidity in children. While standard treatment often involves 14-21 days of antibiotic therapy, the optimal duration of empiric treatment remains debated. This systematic review aimed to compare the effectiveness and safety of short-course empiric antibiotic treatment (<10 days) versus standard-course treatment (14-21 days) in reducing mortality and morbidity in patients with suspected ABM. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted across electronic databases, including EMBASE, MEDLINE, SCOPUS, the Cochrane Library, and clinical trial registries. We included randomized controlled trials (RCTs) and observational studies in which the authors reported and compared antibiotic treatment durations for bacterial meningitis. Data on antibiotics, doses and treatment durations, mortality, neurological sequelae (including hearing loss, developmental delay, and motor deficits), and hospitalization outcomes were extracted and analyzed. Eight studies, all of which were RCTs, involving 1,562 patients were included. Seven studies included pediatric populations, while one included neonates. Short-course therapy (4-10 days) demonstrated clinical outcomes comparable to those of standard-course therapy (14-21 days), with respect to the primary outcomes. No significant differences were observed in mortality rates, the incidence of hearing loss, or long-term neurological sequelae between the treatment groups. Shorter antibiotic courses were associated with a significantly reduced duration of hospitalization (p < 0.05) and lower rates of nosocomial infections. Older studies (pre-2011) used ceftriaxone monotherapy, whereas more recent studies used combination therapy with ceftriaxone and vancomycin. Short-course antibiotic therapy is a safe and effective alternative to standard regimens for pediatric and neonatal bacterial meningitis. Shorter treatment durations may reduce healthcare costs, hospital-acquired infections, and cumulative antibiotic exposure. However, large, multicenter RCTs are needed to further validate combination therapy protocols and support the development of standardized, evidence-based guidelines.