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Review
, 2013 (6), CD004874

Antibiotics for Community-Acquired Pneumonia in Children

Affiliations
Review

Antibiotics for Community-Acquired Pneumonia in Children

Rakesh Lodha et al. Cochrane Database Syst Rev.

Abstract

Background: Pneumonia caused by bacterial pathogens is the leading cause of mortality in children in low-income countries. Early administration of antibiotics improves outcomes.

Objectives: To identify effective antibiotic drug therapies for community-acquired pneumonia (CAP) of varying severity in children by comparing various antibiotics.

Search methods: We searched CENTRAL 2012, Issue 10; MEDLINE (1966 to October week 4, 2012); EMBASE (1990 to November 2012); CINAHL (2009 to November 2012); Web of Science (2009 to November 2012) and LILACS (2009 to November 2012).

Selection criteria: Randomised controlled trials (RCTs) in children of either sex, comparing at least two antibiotics for CAP within hospital or ambulatory (outpatient) settings.

Data collection and analysis: Two review authors independently extracted data from the full articles of selected studies.

Main results: We included 29 trials, which enrolled 14,188 children, comparing multiple antibiotics. None compared antibiotics with placebo.Assessment of quality of study revealed that 5 out of 29 studies were double-blind and allocation concealment was adequate. Another 12 studies were unblinded but had adequate allocation concealment, classifying them as good quality studies. There was more than one study comparing co-trimoxazole with amoxycillin, oral amoxycillin with injectable penicillin/ampicillin and chloramphenicol with ampicillin/penicillin and studies were of good quality, suggesting the evidence for these comparisons was of high quality compared to other comparisons.In ambulatory settings, for treatment of World Health Organization (WHO) defined non-severe CAP, amoxycillin compared with co-trimoxazole had similar failure rates (odds ratio (OR) 1.18, 95% confidence interval (CI) 0.91 to 1.51) and cure rates (OR 1.03, 95% CI 0.56 to 1.89). Three studies involved 3952 children.In children with severe pneumonia without hypoxaemia, oral antibiotics (amoxycillin/co-trimoxazole) compared with injectable penicillin had similar failure rates (OR 0.84, 95% CI 0.56 to 1.24), hospitalisation rates (OR 1.13, 95% CI 0.38 to 3.34) and relapse rates (OR 1.28, 95% CI 0.34 to 4.82). Six studies involved 4331 children below 18 years of age.In very severe CAP, death rates were higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamicin (OR 1.25, 95% CI 0.76 to 2.07). One study involved 1116 children.

Authors' conclusions: For treatment of patients with CAP in ambulatory settings, amoxycillin is an alternative to co-trimoxazole. With limited data on other antibiotics, co-amoxyclavulanic acid and cefpodoxime may be alternative second-line drugs. Children with severe pneumonia without hypoxaemia can be treated with oral amoxycillin in an ambulatory setting. For children hospitalised with severe and very severe CAP, penicillin/ampicillin plus gentamycin is superior to chloramphenicol. The other alternative drugs for such patients are co-amoxyclavulanic acid and cefuroxime. Until more studies are available, these can be used as second-line therapies.There is a need for more studies with radiographically confirmed pneumonia in larger patient populations and similar methodologies to compare newer antibiotics. Recommendations in this review are applicable to countries with high case fatalities due to pneumonia in children without underlying morbidities and where point of care tests for identification of aetiological agents for pneumonia are not available.

Conflict of interest statement

One of the authors (Kabra) was co‐author of one study (Awasthi 2008) included in the review. Other two authors do not have any competing conflicts of interest.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 1 Mean age (months).
1.2
1.2. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 2 Male sex.
1.3
1.3. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 3 Wheezing present.
1.4
1.4. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 4 Cure rate.
1.5
1.5. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 5 Failure rate.
1.6
1.6. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 6 Side effects.
1.7
1.7. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 7 Organisms identified by serology or nasopharyngeal cultures.
1.8
1.8. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 8 Cure rate in radiographically confirmed pneumonia.
1.9
1.9. Analysis
Comparison 1 Azithromycin versus erythromycin, Outcome 9 Failure rate in radiographically confirmed pneumonia.
2.1
2.1. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 1 Age below 5 years.
2.2
2.2. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 2 Cure rates.
2.3
2.3. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 3 Clinical success rate.
2.4
2.4. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 4 Failure rate.
2.5
2.5. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 5 Relapse rate.
2.6
2.6. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 6 Radiologic resolution.
2.7
2.7. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 7 Radiologic success.
2.8
2.8. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 8 Radiologic failure.
2.9
2.9. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 9 Adverse events.
2.10
2.10. Analysis
Comparison 2 Clarithromycin versus erythromycin, Outcome 10 Bacteriologic response.
3.1
3.1. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 1 Cure rate.
3.2
3.2. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 2 Failure rate.
3.3
3.3. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 3 Improved.
3.4
3.4. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 4 Side effects.
3.5
3.5. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 5 Organisms isolated.
3.6
3.6. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 6 Mycoplasma serology positive.
3.7
3.7. Analysis
Comparison 3 Azithromycin versus co‐amoxyclavulanic acid, Outcome 7 Failure rates in radiographically confirmed pneumonia.
4.1
4.1. Analysis
Comparison 4 Azithromycin versus amoxycillin, Outcome 1 Age in months.
4.2
4.2. Analysis
Comparison 4 Azithromycin versus amoxycillin, Outcome 2 Duration of illness.
4.3
4.3. Analysis
Comparison 4 Azithromycin versus amoxycillin, Outcome 3 Wheezing present.
4.4
4.4. Analysis
Comparison 4 Azithromycin versus amoxycillin, Outcome 4 Cure rate clinical.
4.5
4.5. Analysis
Comparison 4 Azithromycin versus amoxycillin, Outcome 5 Cure rate radiological.
4.6
4.6. Analysis
Comparison 4 Azithromycin versus amoxycillin, Outcome 6 Fever day 7.
5.1
5.1. Analysis
Comparison 5 Amoxycillin versus procaine penicillin, Outcome 1 Median age.
5.2
5.2. Analysis
Comparison 5 Amoxycillin versus procaine penicillin, Outcome 2 Failure rate.
6.1
6.1. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 1 Poor or no response.
6.2
6.2. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 2 Cure rate.
6.3
6.3. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 3 Complications.
6.4
6.4. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 4 Age (months).
6.5
6.5. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 5 Weight.
6.6
6.6. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 6 Male sex.
6.7
6.7. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 7 Wheeze present.
6.8
6.8. Analysis
Comparison 6 Co‐amoxyclavulanic acid versus amoxycillin, Outcome 8 Side effects.
7.1
7.1. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 1 Age less than 1 year.
7.2
7.2. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 2 Male sex.
7.3
7.3. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 3 Mean Z score for weight.
7.4
7.4. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 4 Non‐severe pneumonia.
7.5
7.5. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 5 Received antibiotics in previous week.
7.6
7.6. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 6 Severe pneumonia.
7.7
7.7. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 7 Failure rate in non‐severe pneumonia.
7.8
7.8. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 8 Failure rate severe pneumonia clinical diagnosis.
7.9
7.9. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 9 Failure rate radiological positive pneumonia.
7.10
7.10. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 10 Failure rate radiological negative pneumonia.
7.11
7.11. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 11 Death rate.
7.12
7.12. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 12 Lost to follow‐up.
7.13
7.13. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 13 Wheeze positive.
7.14
7.14. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 14 Cure rate.
7.15
7.15. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 15 Change of antibiotics.
7.16
7.16. Analysis
Comparison 7 Co‐trimoxazole versus amoxycillin, Outcome 16 Failure rates after excluding study by Awasthi 2008.
8.1
8.1. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 1 Age less than 1 year.
8.2
8.2. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 2 Age 1 to 5 years.
8.3
8.3. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 3 Age 5 to 12 years.
8.4
8.4. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 4 Duration of illness in days.
8.5
8.5. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 5 Male sex.
8.6
8.6. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 6 Cure rate.
8.7
8.7. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 7 Hospitalisation rate.
8.8
8.8. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 8 Well at end of follow‐up.
8.9
8.9. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 9 Death.
8.10
8.10. Analysis
Comparison 8 Co‐trimoxazole versus procaine penicillin, Outcome 10 Treatment failure.
9.1
9.1. Analysis
Comparison 9 Co‐trimoxazole versus procaine penicillin and ampicillin, Outcome 1 Mean age in months.
9.2
9.2. Analysis
Comparison 9 Co‐trimoxazole versus procaine penicillin and ampicillin, Outcome 2 Age less than 1 year.
9.3
9.3. Analysis
Comparison 9 Co‐trimoxazole versus procaine penicillin and ampicillin, Outcome 3 Male sex.
9.4
9.4. Analysis
Comparison 9 Co‐trimoxazole versus procaine penicillin and ampicillin, Outcome 4 Cure rate.
9.5
9.5. Analysis
Comparison 9 Co‐trimoxazole versus procaine penicillin and ampicillin, Outcome 5 Hospitalisation rate.
9.6
9.6. Analysis
Comparison 9 Co‐trimoxazole versus procaine penicillin and ampicillin, Outcome 6 Death rate.
10.1
10.1. Analysis
Comparison 10 Cefpodoxime versus co‐amoxyclavulanic acid, Outcome 1 Cure rate (response rate) at end of treatment.
10.2
10.2. Analysis
Comparison 10 Cefpodoxime versus co‐amoxyclavulanic acid, Outcome 2 Mean age (months).
10.3
10.3. Analysis
Comparison 10 Cefpodoxime versus co‐amoxyclavulanic acid, Outcome 3 Adverse effects.
10.4
10.4. Analysis
Comparison 10 Cefpodoxime versus co‐amoxyclavulanic acid, Outcome 4 Age in years.
10.5
10.5. Analysis
Comparison 10 Cefpodoxime versus co‐amoxyclavulanic acid, Outcome 5 Follow‐up.
11.1
11.1. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 1 Adverse events.
11.2
11.2. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 2 Death.
11.3
11.3. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 3 Change of antibiotics.
11.4
11.4. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 4 Readmission before 30 days.
11.5
11.5. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 5 Absconded.
11.6
11.6. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 6 Age (months).
11.7
11.7. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 7 Culture positive.
11.8
11.8. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 8 Male sex.
11.9
11.9. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 9 Received antibiotics in previous 1 week.
11.10
11.10. Analysis
Comparison 11 Chloramphenicol versus penicillin plus gentamicin, Outcome 10 Lost to follow‐up.
12.1
12.1. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 1 Mean age.
12.2
12.2. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 2 Male sex.
12.3
12.3. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 3 Number received antibiotics in past 7 days.
12.4
12.4. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 4 Failure rates on day 5.
12.5
12.5. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 5 Failure rates on day 10.
12.6
12.6. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 6 Failure rates on day 21.
12.7
12.7. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 7 Need for change in antibiotics (day 5).
12.8
12.8. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 8 Need for change in antibiotics (day 10).
12.9
12.9. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 9 Need for change in antibiotics (day 21).
12.10
12.10. Analysis
Comparison 12 Chloramphenicol with ampicillin and gentamicin, Outcome 10 Death rates.
13.1
13.1. Analysis
Comparison 13 Chloramphenicol plus penicillin versus ceftriaxone, Outcome 1 Cure rates.
14.1
14.1. Analysis
Comparison 14 Chloramphenicol versus chloramphenicol plus penicillin, Outcome 1 Need for change of antibiotics.
14.2
14.2. Analysis
Comparison 14 Chloramphenicol versus chloramphenicol plus penicillin, Outcome 2 Death rates.
14.3
14.3. Analysis
Comparison 14 Chloramphenicol versus chloramphenicol plus penicillin, Outcome 3 Lost to follow‐up.
15.1
15.1. Analysis
Comparison 15 Ampicillin alone versus penicillin with chloramphenicol, Outcome 1 Cure rates.
15.2
15.2. Analysis
Comparison 15 Ampicillin alone versus penicillin with chloramphenicol, Outcome 2 Age (months).
15.3
15.3. Analysis
Comparison 15 Ampicillin alone versus penicillin with chloramphenicol, Outcome 3 Male sex.
15.4
15.4. Analysis
Comparison 15 Ampicillin alone versus penicillin with chloramphenicol, Outcome 4 Duration of hospital stay.
15.5
15.5. Analysis
Comparison 15 Ampicillin alone versus penicillin with chloramphenicol, Outcome 5 Grade 2 to 4 malnutrition.
16.1
16.1. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 1 Cure rate.
16.2
16.2. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 2 Failure rate.
16.3
16.3. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 3 Male sex.
16.4
16.4. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 4 Age between 2 to 6 years.
16.5
16.5. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 5 Age between 7 to 12 years.
16.6
16.6. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 6 Lost to follow‐up.
16.7
16.7. Analysis
Comparison 16 Benzathine penicillin versus procaine penicillin, Outcome 7 Failure rates in radiographically confirmed pneumonia.
17.1
17.1. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 1 Nasopharyngeal aspirates for S. pneumoniae.
17.2
17.2. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 2 Age less than 1 year.
17.3
17.3. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 3 Male sex.
17.4
17.4. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 4 Weight below 2 Z score (indicating severe malnutrition).
17.5
17.5. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 5 Breast fed.
17.6
17.6. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 6 Received antibiotics in last 7 days.
17.7
17.7. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 7 Failure rate at 48 hours.
17.8
17.8. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 8 Failure rate on day 5.
17.9
17.9. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 9 Failure rate on day 14.
17.10
17.10. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 10 Death rates.
17.11
17.11. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 11 Nasopharyngeal H. influenzae.
17.12
17.12. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 12 Respiratory syncytial virus (RSV) in nasopharyngeal swabs.
17.13
17.13. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 13 Mean age.
17.14
17.14. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 14 Blood culture positive for S. pneumoniae.
17.15
17.15. Analysis
Comparison 17 Amoxycillin versus penicillin, Outcome 15 Failure rate on day 5 in radiographically confirmed pneumonia.
18.1
18.1. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 1 Age below one year.
18.2
18.2. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 2 Male sex.
18.3
18.3. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 3 Wheezing in infants.
18.4
18.4. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 4 Wheezing in age group one to five years.
18.5
18.5. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 5 Failure rates.
18.6
18.6. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 6 Relapse rates.
18.7
18.7. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 7 Death rates.
18.8
18.8. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 8 Lost to follow‐up.
18.9
18.9. Analysis
Comparison 18 Amoxycillin with IV ampicillin, Outcome 9 Protocol violation.
19.1
19.1. Analysis
Comparison 19 Amoxycillin with cefuroxime, Outcome 1 Mean age in months.
19.2
19.2. Analysis
Comparison 19 Amoxycillin with cefuroxime, Outcome 2 Male sex.
19.3
19.3. Analysis
Comparison 19 Amoxycillin with cefuroxime, Outcome 3 Cure rates.
19.4
19.4. Analysis
Comparison 19 Amoxycillin with cefuroxime, Outcome 4 Failure rates.
20.1
20.1. Analysis
Comparison 20 Amoxycillin with clarithromycin, Outcome 1 Mean age.
20.2
20.2. Analysis
Comparison 20 Amoxycillin with clarithromycin, Outcome 2 Male sex.
20.3
20.3. Analysis
Comparison 20 Amoxycillin with clarithromycin, Outcome 3 Cure rates.
20.4
20.4. Analysis
Comparison 20 Amoxycillin with clarithromycin, Outcome 4 Failure rates.
21.1
21.1. Analysis
Comparison 21 Penicillin and gentamycin with co‐amoxyclavulanic acid, Outcome 1 Number of children less than 1 year age.
21.2
21.2. Analysis
Comparison 21 Penicillin and gentamycin with co‐amoxyclavulanic acid, Outcome 2 Male sex.
21.3
21.3. Analysis
Comparison 21 Penicillin and gentamycin with co‐amoxyclavulanic acid, Outcome 3 Failure rates.
22.1
22.1. Analysis
Comparison 22 Levofloxacin with comparator (co‐amoxyclavulanic acid/ceftriaxone), Outcome 1 Mean age.
22.2
22.2. Analysis
Comparison 22 Levofloxacin with comparator (co‐amoxyclavulanic acid/ceftriaxone), Outcome 2 Male sex.
22.3
22.3. Analysis
Comparison 22 Levofloxacin with comparator (co‐amoxyclavulanic acid/ceftriaxone), Outcome 3 Numbers received antibiotics in past 1 week.
22.4
22.4. Analysis
Comparison 22 Levofloxacin with comparator (co‐amoxyclavulanic acid/ceftriaxone), Outcome 4 Cure rates.
23.1
23.1. Analysis
Comparison 23 Cefuroxime with clarithromycin, Outcome 1 Mean age.
23.2
23.2. Analysis
Comparison 23 Cefuroxime with clarithromycin, Outcome 2 Male sex.
23.3
23.3. Analysis
Comparison 23 Cefuroxime with clarithromycin, Outcome 3 Cure rates.
23.4
23.4. Analysis
Comparison 23 Cefuroxime with clarithromycin, Outcome 4 Failure rates.
24.1
24.1. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 1 Age in months.
24.2
24.2. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 2 Male sex.
24.3
24.3. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 3 Weight for age.
24.4
24.4. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 4 Wheezing positive.
24.5
24.5. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 5 Cure rate.
24.6
24.6. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 6 Failure rate.
24.7
24.7. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 7 Excluded.
24.8
24.8. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 8 Relapse rate.
24.9
24.9. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 9 Need for change in antibiotics.
24.10
24.10. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 10 Death rate.
24.11
24.11. Analysis
Comparison 24 Co‐trimoxazole versus chloramphenicol, Outcome 11 Organisms isolated on blood culture or lung puncture.
25.1
25.1. Analysis
Comparison 25 Ceftibuten versus cefuroxime, Outcome 1 Male sex.
25.2
25.2. Analysis
Comparison 25 Ceftibuten versus cefuroxime, Outcome 2 Positive for microbial agent.
25.3
25.3. Analysis
Comparison 25 Ceftibuten versus cefuroxime, Outcome 3 Adverse reaction.
25.4
25.4. Analysis
Comparison 25 Ceftibuten versus cefuroxime, Outcome 4 Cure rate.
25.5
25.5. Analysis
Comparison 25 Ceftibuten versus cefuroxime, Outcome 5 Failure rate.
26.2
26.2. Analysis
Comparison 26 Oxacillin ceftriaxone versus co‐amoxyclavulanic acid, Outcome 2 Male sex.
26.3
26.3. Analysis
Comparison 26 Oxacillin ceftriaxone versus co‐amoxyclavulanic acid, Outcome 3 Mean number of days before admission.
26.4
26.4. Analysis
Comparison 26 Oxacillin ceftriaxone versus co‐amoxyclavulanic acid, Outcome 4 Received antibiotics before enrolment.
26.5
26.5. Analysis
Comparison 26 Oxacillin ceftriaxone versus co‐amoxyclavulanic acid, Outcome 5 Failure rates.
26.6
26.6. Analysis
Comparison 26 Oxacillin ceftriaxone versus co‐amoxyclavulanic acid, Outcome 6 Mean time for improvement in tachypnoea.
26.7
26.7. Analysis
Comparison 26 Oxacillin ceftriaxone versus co‐amoxyclavulanic acid, Outcome 7 Mean length of stay.
27.1
27.1. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 1 Male sex.
27.2
27.2. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 2 Age below 12 months.
27.3
27.3. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 3 Received antibiotics in the past week.
27.4
27.4. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 4 Children with wheezing.
27.5
27.5. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 5 RSV positivity.
27.6
27.6. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 6 Failure rates on day 3.
27.7
27.7. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 7 Failure rates on day 6.
27.8
27.8. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 8 Failure rate in children below 5 years of age.
27.9
27.9. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 9 Failure rates in children receiving oral amoxicillin or injectable antibiotics.
27.10
27.10. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 10 Failure rate in children receiving cotrimoxazole or injectable penicillin.
27.11
27.11. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 11 Failure rate in children treated with oral or parenteral antibiotics on ambulatory basis.
27.12
27.12. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 12 Failure rate after removing one study.
27.13
27.13. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 13 Hospitalisation.
27.14
27.14. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 14 Relapse rates.
27.15
27.15. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 15 Death rates.
27.16
27.16. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 16 Lost to follow‐up.
27.17
27.17. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 17 Cure rate.
27.18
27.18. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 18 Failure rates in radiographically confirmed‐pneumonia.
27.19
27.19. Analysis
Comparison 27 Oral versus parenteral antibiotics for treatment of severe pneumonia, Outcome 19 Death rates after removing one study.
28.1
28.1. Analysis
Comparison 28 Co‐trimoxazole versus co‐amoxyclavulanic acid, Outcome 1 Children below 1 year of age.
28.2
28.2. Analysis
Comparison 28 Co‐trimoxazole versus co‐amoxyclavulanic acid, Outcome 2 Male sex.
28.3
28.3. Analysis
Comparison 28 Co‐trimoxazole versus co‐amoxyclavulanic acid, Outcome 3 Failure rate.
29.1
29.1. Analysis
Comparison 29 Amoxycillin versus cefpodoxime, Outcome 1 Age in months.
29.2
29.2. Analysis
Comparison 29 Amoxycillin versus cefpodoxime, Outcome 2 Male sex.
29.3
29.3. Analysis
Comparison 29 Amoxycillin versus cefpodoxime, Outcome 3 Response/cure rate.
30.1
30.1. Analysis
Comparison 30 Amoxycillin versus chloramphenicol, Outcome 1 Age (mean/median).
30.2
30.2. Analysis
Comparison 30 Amoxycillin versus chloramphenicol, Outcome 2 Male sex.
30.3
30.3. Analysis
Comparison 30 Amoxycillin versus chloramphenicol, Outcome 3 Cure rate.
30.4
30.4. Analysis
Comparison 30 Amoxycillin versus chloramphenicol, Outcome 4 Failure rates.

Update of

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    SK Kabra et al. Cochrane Database Syst Rev (3), CD004874. PMID 20238334. - Review
    There were many studies with different methodologies investigating multiple antibiotics. For treatment of ambulatory patients with CAP, amoxycillin is an alternative to c …

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