The Cochrane Library and Treatment for Community Acquired Pneumonia in Children: An Overview of Reviews

Abstract

AbstractBackgroundGlobally, pneumonia is the leading cause of death among children and also results in significant morbidity. The most common treatment options include anti‐pyretics and antibiotics. Other treatments include vitamins and over‐the‐counter cough syrup.ObjectiveThis overview presents a summary of the results of previous Cochrane reviews on the treatment of community acquired pneumonia (CAP) in children.MethodsThe Cochrane Database of Systematic Reviews was searched for all systematic reviews examining the treatment of pediatric pneumonia or lower respiratory tract infections. All reviews that were under the heading “pneumonia” on the Cochrane Acute Respiratory Infections (ARI) Group's Topic List and the ARI group were consulted. Data were extracted and entered into tables; data were synthesized using qualitative and quantitative methods.Main ResultsEight reviews and one protocol were identified and data were available from seven reviews. Azithromycin and amoxicillin‐clavulanate appeared to be equivalent for CAP in developed countries. In comparing beta‐lactams, one small low‐quality trial showed a higher cure rate with amoxicillin‐clavulanate than with amoxicillin. In comparing macrolides, the efficacy of azithromycin, clarithromycin, and erythromycin appeared to be equal. Azithromycin was better tolerated than was amoxicillin‐clavulanate. For CAP in developing countries, the failure rate was lower for amoxicillin than for co‐trimoxazole. Initial therapy with oral or parenteral antibiotics were equivalent in children with non‐severe pneumonia. A 3‐day course of amoxicillin or of co‐trimoxazole had an equivalent clinical cure rate, treatment failure rate and relapse rate when compared to a 5‐day course. Inconsistent outcomes were shown in studies of vitamin A for therapy of non‐measles pneumonia. There were insufficient children in the studies of over‐the‐counter medications for cough in children with pneumonia to reach meaningful conclusions.ConclusionsAlthough thousands of children have been enrolled in trials of CAP treatments, limited conclusions can be reached about the ideal treatment, route and duration in developed or developing countries and for children of various ages. The primary reason for this is the multitude of interventions studied in diverse populations. Another major problem is that the diagnosis of pneumonia was often clinical rather than radiographic—often by necessity in developing countries. Even when pneumonia was diagnosed radiographically, differentiating viral from bacterial pneumonia was often not practical. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration