Cochrane review: Antibiotics for community acquired pneumonia in children

Abstract

AbstractBackgroundPneumonia is the leading cause of mortality in children. In developing countries, pneumonia is usually caused by bacterial pathogens. The early administration of empirical antibiotics improves the patients' clinical outcomes. There are currently no systematic reviews of clinical trials on this subject.ObjectivesTo identify effective antibiotic drug therapy for community acquired pneumonia (CAP) in children by comparing various antibiotics.Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005), MEDLINE (OVID) (1966 to January 2006) and EMBASE (WebSPIRS) (1990 to September 2005). There were no language restrictions.Selection criteriaRandomized controlled trials (RCTs) in children of either sex, which compared at least two antibiotics for CAP in hospital or ambulatory settings.Data collection and analysisData from full articles of selected studies were independently extracted by two authors.Main resultsThe review of these studies suggests that for treatment of pneumonia, co‐trimoxazole is inferior in efficacy to both amoxycillin (failure rates odds ratio (OR) 1.33; 95% CI 1.05 to 1.67) and procaine penicillin (cure rates OR 2.64; 95% CI 1.57 to 4.45). Penicillin in conjunction with gentamycin was better than chloramphenicol alone (re‐hospitalization rates OR 1.61; 95% CI 1.02 to 2.55). Co‐amoxyclavulanic acid was better than amoxycillin alone (cure rates OR 10.44; 95% CI 2.85 to 38.21). There was no differences between injectable penicillin and oral amoxycillin (failure rates OR 1.03; 95% CI 0.81 to 1.31); azithromycin and erythromycin (cure rates OR 1.17; 95% CI 0.70 to 1.95); cefpodoxime and amoxycillin (cure rates OR 0.69; 95% CI 0.18 to 2.60); or azithromycin and co‐amoxyclavulanic acid (cure rates OR 1.02; 95% CI 0.54 to 1.95, failure rates OR 1.42; 95% CI 0.43 to 4.66).Authors' conclusionsThere were many studies each investigating multiple antibiotics with different methodologies. For treatment of ambulatory patients with CAP, amoxycillin was better than co‐trimoxazole; there was no difference between azithromycin and erythromycin, or between cefpodoxime and co‐amoxyclavulanic acid. For hospitalized patients, procaine penicillin was better than co‐trimoxazole; and the combination of penicillin and gentamycin was better than chloramphenicol alone. Injectable penicillin and oral amoxycillin had similar failure rates. For the rest of the antibiotics there were only single studies available. There is a need for more studies with large patient populations and similar methodologies in order to compare newer antibiotics.Plain language summaryWe compared different antibiotics for community acquired pneumonia in children below 18 years of age in both hospital and ambulatory settingsPneumonia is the leading cause of mortality in children under five years of age. Most community acquired pneumonia in developing countries is caused by bacteria. This systematic review found 20 randomized controlled trials comparing antibiotics, most by single studies only. We found that: for ambulatory treatment of pneumonia, amoxycillin or procaine penicillin are more effective than co‐trimoxazole; for treatment of hospitalized children with pneumonia, a combination of penicillin and gentamycin is more effective than chloramphenicol alone; for hospitalized treatment of pneumonia, oral amoxycillin gives a similar result to injectable penicillin. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.