Comparison of different antibiotics for community acquired pneumonia in children

In developing countries, amoxycillin appears to be equally effective as co-trimoxazole for ambulatory treatment of non-severe community acquired pneumonia (CAP) in children. For children hospitalised with very severe CAP, penicillin/ampicillin plus gentamycin may be superior to chloramphenicol alone.

The quality of evidence is downgraded by imprecise results (wide confidence intervals).

Summary

A Cochrane review included 29 studies with a total of 14 188 children comparing multiple antibiotics. None compared antibiotics with placebo. Most of the studies were conducted in developing countries. For ambulatory treatment of non-severe community acquired pneumonia (CAP), amoxycillin compared with co-trimoxazole (3 studies, n=3 952) had similar failure rates (OR 1.18, 95% CI 0.91 to 1.51) and cure rates (OR 1.03, 95% CI 0.56 to 1.89). In children with severe pneumonia without hypoxaemia, oral antibiotics (amoxycillin/co-trimoxazole) compared with injectable penicillin (6 studies, n=4 331) 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). In very severe CAP death rates seemed to be higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamicin (OR 1.25, 95% CI 0.76 to 2.07; 1 study, n=1 116) although the difference was not statistically significant.

The following decision support rules contain links to this evidence summary:

• Penicillins rather than co-trimoxazole for community-acquired pneumonia in children

Ədəbiyyat

1. Lodha R, Kabra SK, Pandey RM. Antibiotics for community-acquired pneumonia in children. Cochrane Database Syst Rev 2013;(6):CD004874. .