Short antibiotic courses matched long ones in non-severe childhood pneumonia; multi-condition pathways raised guideline adherence across 43 hospitals

The edition in brief

A meta-analysis of ten randomised trials (8,970 children) of non-severe community-acquired pneumonia found no significant difference between courses of 5 days or less and longer courses for treatment failure (RR 1.07, 95% CI 0.93 to 1.24) or relapse (RR 1.04, 0.72 to 1.49), with much lower non-adherence on short courses (RR 0.35, 0.24 to 0.50); the authors note it was not designed to prove non-inferiority. A cluster-randomised trial in 43 general hospitals (11,760 admissions) found that implementing asthma, pneumonia and bronchiolitis pathways together raised composite guideline adherence by 9.9 percentage points and reduced intensive care transfers (adjusted OR 0.69). A Toronto cohort of 5,379 children linked each extra month of exclusive breastfeeding to slightly lower BMI z-score and lower odds of overweight. A single-arm phase 1/2 trial of 144 virologically suppressed adolescents found long-acting injectable cabotegravir plus rilpivirine had no confirmed virological failure through 96 weeks. A national registry study found head CT in about half of children with isolated mild head injury, highest in adult hospitals (59.5%). A pearl on safety-netting after mild head injury closes the edition.