Shorter antibiotics for childhood pneumonia: one emergency department went from 13% to 65% on target

The edition in brief

A US paediatric emergency department used clinical pathways, electronic order-set changes, prescriber education and feedback to raise the share of children discharged with community-acquired pneumonia or acute bacterial sinusitis on a guideline-recommended antibiotic duration from 13.1% to 64.8%, with no rise in return visits within 14 days. Current guidance supports 3–5 days for uncomplicated pneumonia and 5–7 days for sinusitis. A meta-analysis of eight randomised trials (1,000 children) found no significant difference in seizure freedom between levetiracetam and valproate (RR 0.95, 95% CI 0.83–1.09; low-certainty evidence), with fewer adverse events and less weight gain on levetiracetam; exploratory time-to-event analyses favoured valproate. A paediatric systematic review found no overall association between H. pylori infection and asthma (OR 0.75, 95% CI 0.54–1.05); apparent protection appeared only in weaker subgroups. The pearl covers when newborn weight loss needs more than reassurance.