Valeria Molfetta

Background: Short-course antibiotic therapy is increasingly recommended for children with uncomplicated community-acquired pneumonia (CAP), but uncertainty remains about its applicability to bacterial disease and whether antibiotics are needed in routine pediatric outpatient care settings. Methods: We conducted a narrative review of literature published from January 2010 through September 2026. PubMed/MEDLINE, Google Scholar, ClinicalTrials.gov, agency websites, and reference lists were searched. Evidence was synthesized descriptively; no formal risk-of-bias assessment or meta-analysis was performed. Results: Systematic reviews and randomized trials indicate that three- to six-day courses can achieve outcomes comparable to longer regimens in children, mainly outpatients with mild, uncomplicated CAP. However, many trials relied on clinical diagnosis, rarely established etiology, and excluded children with severe disease or major comorbidities. Inclusion of children without bacterial infection may have contributed to similar outcomes across treatment durations; evidence is insufficient to establish efficacy in confirmed bacterial CAP or higher-risk populations. Shorter courses reduce antibiotic exposure among treated children but do not determine who needs antibiotics. Lung ultrasound offers a radiation-free point-of-care approach to identifying pneumonia, while procalcitonin and rapid viral testing may refine etiological assessment. Yet evidence for combined diagnostic strategies largely concerns accuracy rather than outpatient prescribing outcomes. Conclusions: Short courses are supported for carefully selected children with uncomplicated CAP, but their generalizability is limited. Improving diagnosis and identifying children likely to benefit from antibiotics may reduce unnecessary use beyond what shortening treatment alone can achieve. Prospective outpatient studies should evaluate whether integrated imaging, biomarkers, and microbiological tests improve prescribing and clinical outcomes.

Background: Influenza causes substantial seasonal illness in children, particularly infants and young children. Children with chronic conditions, prematurity, neurologic disorders, or immunocompromise are at increased risk of complications. Although antiviral treatment complements vaccination and supportive care, pediatric evidence remains uneven: randomized trials have largely involved otherwise healthy outpatients, while evidence in hospitalized and medically complex children is mostly observational. Methods: This narrative review synthesizes evidence on the mechanisms, clinical use, and limitations of currently available influenza antivirals in children. It prioritizes pediatric trials, observational studies, and clinical guidance, with adult evidence considered where pediatric data are limited. Results: Oseltamivir remains the most widely recommended treatment, particularly for hospitalized children and those at increased risk. Its benefits in uncomplicated illness are generally modest, and vomiting is a recognized adverse effect. Zanamivir and peramivir are alternatives for selected patients, but their use is constrained by inhaled administration, airway disease, intravenous delivery, and limited evidence in severe illness. Baloxavir offers single-dose oral treatment and rapid suppression of viral replication; however, pediatric trials remain relatively small, reduced susceptibility can emerge during treatment, and evidence in severe disease is insufficient. Novel polymerase inhibitors and host-directed therapies remain investigational or have not established a clear clinical role in children. Conclusions: Future research should prioritize infants, children with comorbidities, and hospitalized patients, while addressing age-specific pharmacokinetics, antiviral resistance, and outcomes that matter to children and families.