Summary of findings

azithromycin compared to co-amoxyclavulanic acid for pediatric patients with non-severe pneumonia

 

Patient or population: pediatric patients with non-severe pneumonia

Settings: Ambulatory

Intervention: azithromycin

Comparison: co-amoxyclavulanic acid

Outcomes

Illustrative comparative risks* (95% CI)

Assumed risk                       Corresponding risk

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

 

Co-amoxyclavulanic acid    Azithromycin

 

 

 

 

Failure rate

Study population

OR 1.02  

(0.54 to 1.95)

188 (1 study)

⊕⊝⊝⊝

very low1,2,3

 

667 per 1000

671 per 1000

(519 to 796)

Moderate

                 

Cure rate

Study population

OR 1.21  

(0.42 to 3.53)

276 (2 studies)

⊕⊝⊝⊝

very low4,5

 

54 per 1000

64 per 1000

(23 to 167)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 sequence generation is not mentioned, intention to treat analysis not performed, no details of excluded patients. The study is funded by Pfizer. 

2 One study only

3 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm.

4 Allocation concealment was not adequate in one study. Both studies were funded by Pfizer.

5 No explanation was provided

 

 

 

azithromycin compared to amoxycillin for pediatric patients with non-severe pneumonia

 

Patient or population: pediatric patients with non-severe pneumonia

Settings: Ambulatory

Intervention: azithromycin

Comparison: amoxicillin

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

Assumed risk Corresponding risk

 

Amoxycillin     Azithromycin

 

 

 

 

Cure rate

Study population

OR 2.9  

(0.73 to

11.09)

47 (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

625 per 1000

829 per 1000

(549 to 949)

Moderate

                 

Duration of illness

 The mean duration of illness in the intervention groups was

0.10 lower

(1.5 lower to 1.3 higher)

 

47 (1 study)

⊕⊝⊝⊝

very low1,3,4

 
             

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

 

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 Children in the azithromycin group were significant older. The study was not blinded and concealment of allocation was not adequate. 

2 One study only

3 The study was conducted in Chili

4 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

 

 

 

co-amoxyclavulanic acid compared to amoxycillin for pediatric patients with non-severe pneumonia

 

Patient or population: pediatric patients with non-severe pneumonia

Settings: Ambulatory

Intervention: co-amoxyclavulanic acid

Comparison: amoxicillin

Outcomes

Illustrative comparative risks* (95% CI) Assumed risk         Corresponding risk

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

 

Amoxycillin         Co-amoxyclavulanic acid

 

 

 

 

Cure rate

Study population

RR 10.4  

(2.9 to 38.2)

100 (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

600 per 1000

1000 per 1000

(1000 to 1000)

Moderate

                 
             

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 The study was not blinded and concealment of allocation was inadequate.

2 One study only.

3 The study was conducted in Nigeria.

4 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

 

 

 

co-trimoxazole compared to amoxycillin for pediatric patients with non-severe pneumonia

 

Patient or population: pediatric patients with non-severe pneumonia

Settings: Ambulatory

Intervention: co-trimoxazole

Comparison: amoxicillin

Outcomes

 

Illustrative comparative risks* (95% CI)

Assumed risk         Corresponding risk Amoxycillin           Co-trimoxazole

Relative effect

(95% CI)

 

No of Participants

(studies)

 

Quality of the evidence Comments (GRADE)

                 

Cure rate

Study population

RR 1.03  

(0.56 to 1.89)

1732 (2 studies)

⊕⊝⊝⊝                  very low1,2,3,4

842 per 1000

867 per 1000

(471 to 1000)

Moderate

                 

Failure rate

Study population

 

OR 1.18  

(0.91 to 1.51)

1787 (3 studies)

⊕⊝⊝⊝                          

very low1,3,4

157 per 1000

181 per 1000

(145 to 220)

Moderate

 

 

 

Mortality

Study population

 

OR 2.08  

(0.22 to 20.06)

2050 (2 studies)

   

low  

 

 

Moderate

 

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 One study was not blinded.

2 I=61%

3 The studies were conducted in developing countries.

4 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

 

 

 

Amoxycillin compared to penicillin for pediatric patients with severe pneumonia

 

Patient or population: pediatric patients with severe pneumonia Settings: hospital

Intervention: Amoxycillin

Comparison: penicillin

Outcomes

 

Illustrative comparative risks* (95% CI)

Assumed risk       Corresponding risk

Penicillin                Amoxycillin

Relative effect

(95% CI)

 

No of Participants

(studies)

 

Quality of the evidence Comments (GRADE)

                 

Failure rate

Study population

OR 1.15  

(0.58 to 2.3)

1905 (2 studies)

⊕⊝⊝⊝                           

very low1,2

201 per 1000

224 per 1000

(127 to 367)

Moderate

                 

Mortality

Study population

OR 0.07  (0 to 1.18)

1905 (2 studies)

⊕⊝⊝⊝                           

very low1,3

7 per 1000

1 per 1000

(0 to 9)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 The definition of the outcome differed.

2 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

3 The studies were not blinded.

 

              

 

amoxycillin compared to cefuroxime for pediatric patients with severe pneumonia

 

Patient or population: pediatric patients with severe pneumonia Settings: hospital

Intervention: amoxycillin

Comparison: cefuroxime

Outcomes

 

Illustrative comparative risks* (95% CI)

Assumed risk         Corresponding risk

Cefuroxime             Amoxycillin

Relative effect

(95% CI)

 

No of Participants

(studies)

 

Quality of the evidence Comments (GRADE)

                 

Cure rate

Study population

OR 2.05  

(0.18 to 23.51)

84 (1 study)

⊕⊝⊝⊝                          

very low1,2,3,4

952 per 1000

976 per 1000

(783 to 998)

Moderate

                 

Failure rate

Study population

OR 0.49  

(0.04 to 5.59)

84 (1 study)

⊕⊝⊝⊝                          

very low1,3,4

48 per 1000

24 per 1000

(2 to 218)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 The study was not blinded.

2 One study only.

3 The study was conducted in Pakistan.

4 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

 

 

 

amoxycillin compared to clarithromycin for pediatric patients with severe pneumonia

 

Patient or population: pediatric patients with severe pneumonia Settings: hospital

Intervention: amoxycillin

Comparison: clarithromycin

Outcomes

Illustrative comparative risks* (95% CI)

Assumed risk              Corresponding risk

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

 

Clarithromycin            Amoxycillin

 

 

 

 

Cure rate

Study population

OR 1.05  

(0.06 to 17.04)

82 (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

975 per 1000

976 per 1000

(701 to 998)

Moderate

                 

Failure rate

Study population

RR 0.95  

(0.06 to 15.74)

82 (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

25 per 1000

24 per 1000

(1 to 393)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

 

 

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 The study was not blinded.

2 One study only.

3 The study was conducted in Pakistan.

4 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

 

 

 

cefuroxime compared to clarithromycin for pediatric patients with severe pneumonia

 

Patient or population: pediatric patients with severe pneumonia Settings: hospital

Intervention: cefuroxime

Comparison: clarithromycin

Outcomes

 

Illustrative comparative risks* (95% CI)

Relative effect

(95% CI)

 

No of Participants

(studies)

 

Quality of the evidence (GRADE)

 

Comments

 

Assumed risk              Corresponding risk

Clarithromycin             Cefuroxime

Cure rate

Study population

OR 0.51  

(0.04 to 5.89)

82 (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

975 per 1000

952 per 1000

(609 to 996)

Moderate

                 

Failure rate

Study population

RR 0.51  

(0.04 to 5.89)

82 (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

975 per 1000

497 per 1000

(39 to 1000)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 The study was not blinded.

2 One study only.

3 The study was conducted in Pakistan.

4 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm. 

 

 

 

oral amoxycillin compared to injectable antibiotics for patients <5 yrs of age with severe CAP

 

Patient or population: patients <5 yrs of age with severe CAP Settings: 

Intervention: oral amoxycillin

Comparison: injectable antibiotics

Outcomes

 

Illustrative comparative risks* (95% CI)

Assumed risk              Corresponding risk

Injectable antibiotics Oral amoxycillin

Relative effect

(95% CI)

 

No of Participants

(studies)

 

Quality of the evidence Comments (GRADE)

                 

Failure rate

Study population

 

OR 0.91  

(0.77 to 1.22)

3802 (2 studies)

   

low  

154 per 1000

142 per 1000

(123 to 182)

Moderate

 

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 The studies were not blinded.

2 The studies were conducted in developing countries.

 

 

 

oral amoxycillin compared to oral cotrimoxazole and referral for patients <5 yrs of age with severe CAP

 

Patient or population: patients <5 yrs of age with severe CAP Settings: 

Intervention: oral amoxycillin

Comparison: oral cotrimoxazole and referral

Outcomes

Illustrative comparative risks* (95% CI)

Assumed risk                          Corresponding risk

Relative effect No of Participants

(95% CI)           (studies)

Quality of the evidence (GRADE)

Comments

 

Oral cotrimoxazole and refer- Oral amoxycillin ral

                 

 

 

Failure rate

Study population

OR 0.51            7621

(0.4 to 0.64)      (2 studies)

⊕⊝⊝⊝

very low1,2,3

 

150 per 1000

83 per 1000

(66 to 102)

Moderate

                 
           

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 Bari: enrolment of more cases in the intervention clusters than in the control clusters, probably attributable to knowledge that treatment services for severe pneumonia were available in the community in intervention clusters. Soofi: heterogenity of enrolment of patients 2 I-squared=62%

3 developing countries.

 

 

 

oral amoxycillin compared to injectable antibiotics or oral cotrimoxazole/referral for patients <5 yrs of age with severe CAP

 

Patient or population: patients <5 yrs of age with severe CAP Settings: 

Intervention: oral amoxycillin

Comparison: injectable antibiotics or oral cotrimoxazole/referral

Outcomes

Illustrative comparative risks* (95% CI) Assumed risk

Corresponding risk

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

 

Injectable antibiotics or oral cotrimoxazole/referral

Oral amoxycillin

 

 

 

 

Failure rate

Study population

 

OR 0.67         11423

(0.47 to 0.95) (4 studies)

⊕⊝⊝⊝                 

very low1,2,3

152 per 1000

107 per 1000

(77 to 145)

Moderate

 

 

 

Mortality on day 6

Study population

 

OR 0.4           0

(0.12 to 1.31) (4 studies)

See comment         

See comment

See comment

Moderate

 

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 Two studies were not blinded.

2 I-squared=89%

3 Developing countries.

 

 

 

oral amoxycillin / co-trimoxazole compared to intravenous penicillin/amplicillin / intramuscular penicillin for pediatric patients with pneumonia

 

Patient or population: pediatric patients with pneumonia Settings: 

Intervention: oral amoxycillin / co-trimoxazole

Comparison: intravenous penicillin/amplicillin / intramuscular penicillin

Outcomes

Illustrative comparative risks* (95% CI)

Assumed risk                                         Corresponding risk

Intravenous penicillin/amplicillin / Oral amoxycillin / co-

intramuscular penicillin                        trimoxazole

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

 

 

 

 

 

Failure rate

Study population

RR 0.84  

(0.56 to

1.24)

3870 (3 studies)

⊕⊝⊝⊝

very low1,2,3

 

155 per 1000

130 per 1000

(87 to 192)

Moderate

                 

Cure rate

Study population

RR 5.05  

(1.19 to

21.33)

0

(2 studies)

See comment

 

See comment                                           See comment

Moderate

                 

Hospitalisation rate

Study population

RR 1.13  

(0.38 to

3.34)

458 (3 studies)

⊕⊝⊝⊝

very low1,3,4

 

26 per 1000

30 per 1000

(10 to 88)

Moderate

                 

Mortality

Study population

RR 0.15  

(0.03 to

0.87)

3942 (3 studies)

⊕⊕⊝⊝

low5,6

 

6 per 1000

1 per 1000

(0 to 5)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 All studies were unblinded. Concealment of allocation was inadequate in one study. 

 

 

 

2 Developing countries.

3 Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm.

4 One study was conducted in Istanbul and one study in Gambia.

5 The studies were not blinded.

6 Two of the three studies were conducted in developing countries.

 

 

 

short compared to long course antibiotic therapy for patients aged 2-59 months with non-severe CAP

 

Patient or population: patients aged 2-59 months with non-severe CAP Settings: 

Intervention: short

Comparison: long course antibiotic therapy

Outcomes

Illustrative comparative risks* (95% CI)

Assumed risk                   Corresponding risk

Relative effect (95% CI)

No of Participants (studies)

Quality of the evidence (GRADE)

Comments

 

Long course antibiotic        Short therapy

 

 

 

 

Clinical cure rate

Study population

RR 0.99  

(0.97 to 1.01)

5763 (3 studies)

⊕⊝⊝⊝

very low1,2

 

900 per 1000

891 per 1000

(873 to 909)

Moderate

                 

Treatment failure

Study population

RR 1.07  

(0.92 to 1.25)

5763 (3 studies)

⊕⊝⊝⊝

very low1,2

 

100 per 1000

107 per 1000

(92 to 125)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1                   Two studies (Agarwal and MASCOT) were of adequate methodological quality, but Agarwal was not clear about blinding. In the other study (Kartasasmita) there was insufficient information to make any judgement. 

2                   All studies were conducted in developing countries. Many of the infants included would be defined as having bronchioltis with wheeze. Some had upper respiratory tract infections. Most of these children may not have needed antibiotics at all in developed countries.

 

 

 

azithromycin and symptom-specific agents compared to symptom-specific agents for children, aged 1-14 years with ARTI

 

Patient or population: children, aged 1-14 years with ARTI Settings: 

Intervention: azithromycin and symptom-specific agents

Comparison: symptom-specific agents

Outcomes

Illustrative comparative risks* (95% CI) Assumed risk         Corresponding risk

Relative No of Particieffect                 pants

(95% CI)        (studies)

Quality of the evidence (GRADE)

Comments

 

Symptom-specific   Azithromycin and symptom-

agents                        specific agents

                 

 

 

Clinical cure at 1 month

Study population

RR 1.29          190

(1.17 to 1.43) (1 study)

⊕⊝⊝⊝

very low1,2,3

 

772 per 1000

996 per 1000

(903 to 1000)

Moderate

                 

Clinical cure at 6 months

Study population

RR 1.31          180

(1.05 to 1.63) (1 study)

⊕⊝⊝⊝

very low1,2,3

 

560 per 1000

733 per 1000

(588 to 912)

 

Moderate

 

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

1 Funded by Pfizer.

2 One study only

3 No distinction was made between upper en lower respiratory tract infections. C. pneumoniae and M. pneumoniae were grouped toghether. 

 

 

 

azithromycin compared to amoxicillin/clavunalate for patients 0.5-16 yrs with CAP

 

Patient or population: patients 0.5-16 yrs with CAP Settings: 

Intervention: azithromycin

Comparison: amoxicillin/clavunalate

Outcomes

Illustrative comparative risks* (95% CI)

Assumed risk                    Corresponding risk

Relative         No of Participants Quality of the

effect              (studies)                evidence

(95% CI)                                         (GRADE)

Comments

 

Amoxicillin/clavunalate         Azithromycin

                 

 

 

Clinical cure at 15-19 days

Study population

RR 1.01           188

(0.81 to 1.25) (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

667 per 1000

673 per 1000

(540 to 833)

Moderate

                 

Clinical cure at 4 to 6 weeks

Study population

RR 1.00           162

(0.87 to 1.15) (1 study)

⊕⊝⊝⊝

very low1,3,5

 

854 per 1000

854 per 1000

(743 to 982)

Moderate

                 

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

1  Harris (1998) is unclear about concealment of allocation and blinding. The study was funded by Pfizer.

2  One study only.

3  Only 30 of the 188 patients <5 yrs of age had M. pneumoniae.

4  Number of events <<300.

5  No explanation was provided

 

 

 

azithromycin compared to amxoycillin for children aged 1 month to 14 yrs with classic CAP

 

Patient or population: children aged 1 month to 14 yrs with classic CAP Settings: ambulatory

Intervention: azithromycin

Comparison: amxoycillin

 

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect No of Participants   Quality of the evi-

Comments

 

Assumed risk        Corresponding risk

(95% CI)

(studies)

dence (GRADE)

 

Amxoycillin            Azithromycin

 

 

                 

Clinical cure at day 7

Study population

RR 1.42  

(0.96 to 2.08)

47 (1 study)

⊕⊝⊝⊝                        

very low1,2,3,4

583 per 1000

828 per 1000

(560 to 1000)

Moderate

                 
             

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; RR: Risk ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

 

[1] Kogan (2003) is unclear about concealment of allocation and blinding.

[2] One study only.

[3] Only 23 of the 59 patients had M. pneumoniae.

[4] Number of evens <<300.

 

 

 

azithromycin compared to co-amoxyclavulanic acid for children with radiologically confirmed pneumonia

 

Patient or population: children with radiologically confirmed pneumonia Settings: 

Intervention: azithromycin

Comparison: co-amoxyclavulanic acid

Outcomes

 

Illustrative comparative risks* (95% CI)

Assumed risk                       Corresponding risk

Co-amoxyclavulanic acid    Azithromycin

Relative effect No of Participants

(95% CI)            (studies)

                 

Quality of the evidence (GRADE)

 

Comments

 

Failure rate

Study population

OR 0.62             88

(0.05 to 7.08)    (1 study)

⊕⊝⊝⊝

very low1,2,3,4

 

41 per 1000

26 per 1000

(2 to 232)

Moderate

                 
           

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

 

CI: Confidence interval; OR: Odds ratio; 

 

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.


[1] Wubbel (1999) was unclear about concealment of allocation. The study was not blinded.

[2] One study only.

[3] Only 12 of the 168 children had M. pneumoniae.

[4] Total number of events is less than 300 and 95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm.