E-DRUG: Treatment of non-severe pneumonia in children <5 years
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[This is a new review from the Cochrane Database of Systematic Reviews
showing that a 3 days' course of antibiotic for non-severe
community-acquired pneumonia for children under 5 years of age seems to
be as effective as a longer treatment. But please note that that there
is a need for more good trials. KM]
[Intervention Review]
Short-course versus long-course antibiotic therapy for non-severe
community-acquired pneumonia in children aged 2 months to 59 months
Batool A Haider1, Muhammad Ammad Saeed1, Zulfiqar A Bhutta. Department
of Paediatrics and Child Health, The Aga Khan University, Karachi,
Pakistan
Contact address: Prof Zulfiqar A Bhutta, Husein Laljee Dewraj Professor
of Paediatrics, Department of Paediatrics and Child Health, The Aga Khan
University, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan.
zulfiqar.bhutta@aku.edu. (Editorial group: Cochrane Acute Respiratory
Infections Group.)
Cochrane Database of Systematic Reviews, Issue 2, 2008 (Status in this
issue: New)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &
Sons, Ltd.
DOI: 10.1002/14651858.CD005976.pub2
This version first published online: 16 April 2008 in Issue 2, 2008.
Re-published online with edits: 14 February 2008 in Issue 2, 2008. Last
assessed as up-to-date: 4 September 2007.
This record should be cited as: Haider BA, Saeed MA, Bhutta ZA.
Short-course versus long-course antibiotic therapy for non-severe
community-acquired pneumonia in children aged 2 months to 59 months.
Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.:
CD005976. DOI: 10.1002/14651858.CD005976.pub2.
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http://www.cochrane.org/reviews/
Abstract
Background
Pneumonia is the leading cause of mortality in children under five years
of age. Treatment of pneumonia requires an effective antibiotic used in
adequate doses for an appropriate duration. Recommended duration of
treatment ranges between 7 and 14 days, but this is not based on any
empirical evidence. Shorter duration of therapy, if found to be
effective, could be particularly important in resource-poor settings
where there is a high risk of death, poor access to medicines and health
care, and limited budgets for medicines.
Objectives
To evaluate the efficacy of short-course versus long-course therapy with
the same antibiotic for non-severe community-acquired pneumonia in
children aged 2 to 59 months.
Search strategy
We searched The Cochrane Central Register of Controlled Trials
(CENTRAL); the Database of Abstracts of Reviews of Effects (DARE) (The
Cochrane Library, 2007, Issue 3); MEDLINE (OVID) (January 1966 to
September 2007); EMBASE (Embase.com) (1974 to September 2007); and
LILACS (1982 to September 2007).
Selection criteria
All randomized controlled trials (RCTs) evaluating the efficacy of
short-course versus long-course therapy using the same antibiotic for
non-severe community-acquired pneumonia in children.
Data collection and analysis
Two review authors independently assessed trial quality and extracted
the data.
Main results
Three studies (5763 children) were included. Analysis of three days
versus five days of treatment with the same antibiotic for non-severe
pneumonia in children showed non-significant differences in rates of
clinical cure at the end of treatment (RR 0.99; 95% CI 0.97 to 1.01),
treatment failure at the end of treatment (RR 1.07; 95% CI 0.92 to 1.25)
and relapse rate after seven days of clinical cure (RR 1.09; 95% CI 0.83
to 1.42). Subgroup analysis evaluating the impact of different
antibiotics showed non-significant differences for these outcomes with
different durations of therapy.
Authors' conclusions
The evidence of this review suggests that a short course (three days) of
antibiotic therapy is as effective as a longer treatment (five days) for
non-severe pneumonia in children under five years of age. However, there
is a need for more well-designed RCTs to support our review findings.
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Plain language summary
Comparing different durations of the same antibiotic therapy for
non-severe community-acquired pneumonia in children under five years of
age Pneumonia is a major cause of mortality in children under five years
of age. Treatment of pneumonia requires the use of an effective
antibiotic in adequate doses for an appropriate duration. In most cases,
treatment ranges between 7 and 14 days, but this is not based on any
empirical evidence. Shorter duration of therapy, if found to be
effective, would not only be beneficial in resource-poor settings but
also result in improved adherence to therapy and reduced resistance to
antibiotics. This review of three studies involving 5763 children found
that a short course (three days) of antibiotic therapy is equally as
effective as a longer treatment (five days) for non-severe pneumonia. We
also found that different durations of either amoxicillin or
cotrimoxazole give similar results in terms of clinical cure, failure of
the treatment and rate of relapse.