Intervention Review

Oral antibiotics versus parenteral antibiotics for severe pneumonia in children

  1. Maria Ximena Rojas-Reyes1,*,
  2. Claudia Granados Rugeles2

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 19 APR 2006

Assessed as up-to-date: 29 JUN 2005

DOI: 10.1002/14651858.CD004979.pub2


How to Cite

Rojas-Reyes MX, Granados Rugeles C. Oral antibiotics versus parenteral antibiotics for severe pneumonia in children. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004979. DOI: 10.1002/14651858.CD004979.pub2.

Author Information

  1. 1

    Pontificia Universidad Javeriana, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Bogota, DC, Colombia

  2. 2

    Pontificia Universidad Javeriana, Department of Paediatrics, Faculty of Medicine, Bogota, DC, Colombia

*Maria Ximena Rojas-Reyes, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Cr. 7 #40-62, 2nd floor, Bogota, DC, Colombia. mxrojas@gmail.com. mxrojas@javeriana.edu.co.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality in children under five years of age in developing countries. When hospitalisation is required, the usual practice includes administering parenteral antibiotics if a bacterial infection is suspected. This has disadvantages as it causes pain and discomfort to the children, which may lead to treatment refusal or reduced compliance. It is also associated with needle-related complications. In some settings this equipment is in short supply or unavailable necessitating transfer of the child, which increases risks and healthcare costs.

Objectives

To determine the equivalence in effectiveness and safety of oral antibiotic compared to parenteral antibiotic therapies in the treatment of severe pneumonia in children between three months and five years of age.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2005, issue 2) which contains the Acute Respiratory Infections Group's specialized register; MEDLINE (January 1966 to July 2005); EMBASE (January 1990 to July 2005) and LILACS (February 2005).

Selection criteria

The review included published or unpublished randomised controlled trials (RCTs) and quasi-RCTs comparing any oral antibiotic therapy with any parenteral antibiotic therapy for the treatment of severe pneumonia in children from three months to five years of age.

Data collection and analysis

The search yielded more than 1300 titles. Only three studies met all criteria for eligibility. One of the identified trials is yet to publish its results. We did not perform a meta-analysis because of clinical heterogeneity of therapies compared in the included trials.

Main results

Campbell 1988 compared oral co-trimoxazole versus intramuscular procaine penicillin followed by oral ampicillin in 134 children. At the seventh day of follow up, treatment failure occurred in 6/66 (9.1%) in the oral co-trimoxazole group and 7/68 (10.2%) in the combined-treatment group. The risk difference was -0.01% (95% confidence interval (CI) -0.11 to 0.09). The APPIS Group 2004 evaluated 1702 patients comparing oral amoxicillin versus intravenous penicillin for two days followed by oral amoxicillin. After 48 hours, treatment failure occurred in 161/845 (19%) in the amoxicillin group and 167/857 (19%) in the parenteral penicillin group. The risk difference was -0.4% (95% CI -4.2 to 3.3). The authors reported similar recovery in both groups at 5 and 14 days.

Authors' conclusions

Oral therapy appears to be an effective and safe alternative to parenteral antibiotics in hospitalised children with severe pneumonia who do not have any serious signs or symptoms.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Oral antibiotics appear to be as effective as parenteral antibiotics in the treatment of severe pneumonia in children

Acute respiratory infection (including pneumonia) is one of the leading causes of morbidity and mortality in children under five years of age in developing countries. Antibiotics are needed when a bacterial infection is suspected. When children are hospitalised they often receive injectable antibiotics. This has disadvantages: pain, risk of other infections and cost. There are studies that show that oral antibiotics are effective when children are treated as outpatients. The objective of this review was to determine the effectiveness and safety of oral antibiotics compared to parenteral antibiotics in the treatment of pneumonia in children less than five years old. Oral therapy appears to be an effective and safe alternative to parenteral antibiotics in hospitalised children with severe pneumonia who do not have any serious signs or symptoms. There is currently insufficient evidence to determine the relative benefits and harms of oral antibiotics in children with severe pneumonia if serious signs and symptoms are present or in children with severe pneumonia associated with bacterial confirmation or lobar consolidation on chest X-ray.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

兒童嚴重肺炎中口服與注射抗生素之比較

急性呼吸道感染(ARI)是開發中國家5歲以下幼兒常見造成發病和死亡常見原因之一。當有需要住院時,若疑似為細菌感染,常規的處置包括抗生素的注射。這方面有一些缺點,因為這會對兒童造成疼痛和不舒服,進而導致患者拒絕治療或對治療的順從度降低。這也跟注射針頭導致的併發症有關。在一些機構當中設備供不應求,或是無法順利提供給兒童使用,進而提高了風險及健康照護成本。

目標

探討口服抗生素與注射抗生素在治療年齡介於3個月至5歲兒童嚴重肺炎的療效與安全之等效性。

搜尋策略

我們搜尋了考科藍臨床試驗之中央登錄(考科藍圖書館, Issue 2, 2005)、MEDLINE(1966年1月至2005年7月)和EMBASE(1990年1月至2005年7月)以及LILACS(2005年2月)。

選擇標準

這篇文獻回顧包含了比較任何口服與注射抗生素在治療3個月大至5歲大兒童嚴重肺炎之已發表或未發表隨機對照實驗(RCTs)以及半隨機對照實驗。

資料收集與分析

搜尋產生超過1300個項目。只有3項研究達到合格標準。在這些被挑選出來的試驗中有一個即將發表它的結果。我們沒有執行統合分析,因為與所包括的試驗比較起來這些治療有臨床異質性。

主要結論

Campbell在1988年對134兒童進行口服cotrimoxazole與肌肉注射procaine penicillin後口服ampicillin之比較。在進行追蹤的第七天,在口服cotrimoxazole組別有6/66(9%)治療失敗,而在合併使用組 有7/68(10.2%)治療失敗。風險差異為 −0.01%(95%信賴區間(CI)為 −0.11至0.09)。在APPIS小組在2004年評估了1702名病患比較口服amoxicillin與靜脈注射penicillin兩天後口服amoxicillin。在經過四十八小時後,amoxicillin組別中有161/845(19%)治療失敗而靜脈注射penicillin組別中有167/857(19%)治療失敗。危險性差別為 −0.4%(95%信賴區間 −4.2至3.3)。這些作者報導了兩組於第五天和第十四天的恢復是相似的。

作者結論

針對治療沒有嚴重徵狀的嚴重肺炎住院兒童,口服抗生素似乎為是注射抗生素之外,另一個有效和安全之選擇。

翻譯人

本摘要由臺灣大學附設醫院林祖燊翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

口服抗生素在治療兒童嚴重肺炎與注射抗生素一樣有效。急性呼吸道感染(包括肺炎)為開發中國家5歲以下兒童造成發病與死亡的主要原因之一。當疑似有細菌感染,抗生素的使用是必要的。當兒童住院後,他們通常會接受注射抗生素。這樣的處置是有缺點的: 疼痛、其他感染的風險以及成本花費。研究顯示當兒童藉由門診的方式以口服抗生素治療效果是一樣的。這篇評論的目的在於探討口服抗生素與注射抗生素在治療小於5歲兒童肺炎的效果和安全。這篇評論包含了比較這兩種抗生素給藥方式治療肺炎的隨機對照實驗和準隨機對照實驗。只有3篇研究達到標準,而29篇被拒絕納入。三篇中有兩篇已被發表。Campbell 1988對134兒童進行口服cotrimoxazole與肌肉注射procaine penicillin後口服ampicillin之比較。在追蹤時發現兩組有相同的恢復。APPIS小組2004年評估了1702名病患比較口服amoxicillin與靜脈注射penicillin兩天後口服amoxicillin。他們證實了兩種治療在效用和安全是等效的。口服抗生素比起注射抗生素在治療沒有任何嚴重徵狀之嚴重肺炎之住院兒童似乎為一有效和安全之選擇。 針對嚴重肺炎的兒童(出現嚴重徵狀、或細菌性肺炎、或X光呈大葉性實質化),目前並沒有證據可以確認採用口服抗生素治療的利弊。