GRADE Evidence Profiles

Author(s): Leonie Venmans Date: 2013-09-04

Question: Should azithromycin vs co-amoxyclavulanic acid be used in pediatric patients with non-severe pneumonia? Settings: Ambulatory

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Azithromycin

Co amoxyclavulanic

acid

Relative (95% CI)

Absolute

Failure rate

randomised

trials

very serious¹

no serious inconsistency²

no serious indirectness

serious³

none

84/125

(67.2%)

42/63

(66.7%)

OR 1.02

(0.54 to

1.95)

4 more per

1000 (from

147 fewer to 129 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

Cure rate

randomised

trials

very serious⁴

no serious inconsistency

no serious indirectness

serious⁵

none

12/164 (7.3%)

6/112 (5.4%)

OR 1.21

(0.42 to

3.53)

11 more per

1000 (from

30 fewer to

⊕ΟΟΟ

VERY

LOW

CRITICAL

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

²One study only

³Total 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.

⁴Allocation concealment was not adequate in one study. Both studies were funded by Pfizer. ⁵ No explanation was provided

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should azithromycin vs amoxycillin be used in pediatric patients with non-severe pneumonia? Settings: Ambulatory

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Azithromycin

Amoxycillin

Relative

(95% CI)

Absolute

Cure rate

19/23

(82.6%)

15/24

(62.5%)

1 randomised very no serious serious³ serious⁴ none OR 2.9 204 more per ⊕ΟΟΟ CRITICAL trials serious inconsistency² (0.73 to 1000 (from 76 VERY

11.09) fewer to 324 LOW more)

Duration of illness (Better indicated by lower values)

randomised

trials

very serious¹

no serious inconsistency

serious³

serious⁴

none

MD 0.10 lower

(1.5 lower to

1.3 higher)

⊕ΟΟΟ

VERY

LOW

CRITICAL

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

²One study only

³The study was conducted in Chili

⁴Total 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.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should co-amoxyclavulanic acid vs amoxycillin be used in pediatric patients with non-severe pneumonia? Settings: Ambulatory

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Coamoxyclavulanic

acid

Amoxycillin

Relative

(95% CI)

Absolute

Cure rate

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

47/50 (94%)

30/50 (60%)

RR 10.4

(2.9 to

38.2)

1000 more per 1000

(from 1000 more to 1000 more)

⊕ΟΟΟ

VERY

LOW

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

²One study only.

³The study was conducted in Nigeria.

⁴Total 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.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should co-trimoxazole vs amoxycillin be used in pediatric patients with non-severe pneumonia? Settings: Ambulatory

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Cotrimoxazole

Amoxycillin

Relative

(95% CI)

Absolute

Cure rate

randomised

trials

serious¹

serious²

serious³

serious⁴

none

720/872 (82.6%)

724/860 (84.2%)

RR 1.03

(0.56 to

1.89)

25 more per

1000 (from

370 fewer to

749 more)

⊕ΟΟΟ

VERY

LOW

Failure rate

randomised

trials

serious¹

no serious inconsistency

serious³

serious⁴

none

166/948 (17.5%)

132/839 (15.7%)

OR 1.18

(0.91 to

1.51)

23 more per

1000 (from 12 fewer to 63 more)

⊕ΟΟΟ

VERY

LOW

Mortality

randomised

trials

no serious risk of bias

no serious inconsistency

serious³

serious⁴

none

2/1132 (0.18%)

0/918 (0%)

OR 2.08

(0.22 to

20.06)

⊕⊕ΟΟ LOW

CRITICAL

¹One study was not blinded.

²I=61%

³The studies were conducted in developing countries.

⁴95% CI around the pooled estimate of effect includes both 1) no effect and 2) appreciable benefit or appreciable harm.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should Amoxycillin vs penicillin be used in pediatric patients with severe pneumonia?

Settings: hospital

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Amoxycillin

Penicillin

Relative

(95% CI)

Absolute

Failure rate

randomised

trials

serious

no serious inconsistency

serious¹

serious²

none

192/960 (20%)

190/945 (20.1%)

OR 1.15

(0.58 to

2.3)

23 more per

1000 (from 74 fewer to 166 more)

⊕ΟΟΟ

VERY

LOW

Mortality

randomised

trials

serious³

no serious inconsistency

serious¹

serious

none

0/945 (0%)

7/960

(0.73%)

OR 0.07 (0 to 1.18)

7 fewer per

1000 (from 7 fewer to 1 more)

⊕ΟΟΟ

VERY

LOW

¹The definition of the outcome differed.

²Total 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.

³The studies were not blinded.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should amoxycillin vs cefuroxime be used in pediatric patients with severe pneumonia?

Settings: hospital

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Amoxycillin

Cefuroxime

Relative

(95% CI)

Absolute

Cure rate

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

41/42

(97.6%)

40/42

(95.2%)

OR 2.05

(0.18 to

23.51)

24 more per

1000 (from 170 fewer to 45 more)

⊕ΟΟΟ

VERY

LOW

Failure rate

randomised

trials

serious¹

no serious inconsistency

serious³

serious⁴

none

1/42

(2.4%)

2/42

(4.8%)

OR 0.49 (0.04 to

24 fewer per

1000 (from 46

⊕ΟΟΟ

5.59)

fewer to 171 more)

VERY LOW

¹The study was not blinded.

²One study only.

³The study was conducted in Pakistan.

⁴Total 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.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should amoxycillin vs clarithromycin be used in pediatric patients with severe pneumonia?

Settings: hospital

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Amoxycillin

Clarithromycin

Relative

(95% CI)

Absolute

Cure rate

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

41/42

(97.6%)

39/40

(97.5%)

OR 1.05

(0.06 to

17.04)

1 more per

1000 (from

274 fewer to

⊕ΟΟΟ

VERY

LOW

Failure rate

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

1/42

(2.4%)

1/40

(2.5%)

RR 0.95

(0.06 to

15.74)

1 fewer per

1000 (from 24 fewer to 368 more)

⊕ΟΟΟ

VERY

LOW

¹The study was not blinded.

²One study only.

³The study was conducted in Pakistan.

⁴Total 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.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should cefuroxime vs clarithromycin be used in pediatric patients with severe pneumonia?

Settings: hospital

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Cefuroxime

Clarithromycin

Relative

(95% CI)

Absolute

Cure rate

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

40/42

(95.2%)

39/40

(97.5%)

OR 0.51

(0.04 to

5.89)

23 fewer per

1000 (from

366 fewer to

⊕ΟΟΟ

VERY

LOW

Failure rate

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

40/42

(95.2%)

39/40

(97.5%)

RR 0.51

(0.04 to

5.89)

478 fewer per

1000 (from

936 fewer to

1000 more)

⊕ΟΟΟ

VERY

LOW

¹The study was not blinded.

²One study only.

³The study was conducted in Pakistan.

⁴Total 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.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should oral amoxycillin vs injectable antibiotics be used in patients <5 yrs of age with severe CAP? Settings:

Bibliography: Das RR, Singh M. Treatment of severe community-acquired pneumonia with oral amoxicillin in under-five children in developing country: a systematic review. PLoS ONE 2013; 8(6): e66232.

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Oral amoxycillin

Injectable antibiotics

Relative (95% CI)

Absolute

Failure rate

randomised

trials

serious¹

no serious inconsistency

serious²

no serious imprecision

none

274/1909 (14.4%)

292/1893 (15.4%)

OR 0.91

(0.77 to

1.22)

12 fewer per

1000 (from 31 fewer to 28

⊕⊕ΟΟ LOW

CRITICAL

more)

¹The studies were not blinded.

²The studies were conducted in developing countries.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should oral amoxycillin vs oral cotrimoxazole and referral be used in patients <5 yrs of age with severe CAP?

Settings:

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Oral amoxycillin

Oral cotrimoxazole and refer-

ral

Relative (95% CI)

Absolute

Failure rate

randomised

trials

serious¹

serious²

serious³

no serious imprecision

none

352/4198 (8.4%)

514/3423 (15%)

OR 0.51

(0.4 to

0.64)

67 fewer per

1000 (from

49 fewer to

84 fewer)

⊕ΟΟΟ

VERY

LOW

CRITICAL

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.

Author(s): Leonie Venmans Date: 2013-09-09

Question: Should oral amoxycillin vs injectable antibiotics or oral cotrimoxazole/referral be used in patients <5 yrs of age with severe CAP?

Settings:

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Oral amoxycillin

Injectable antibiotics or oral

cotrimoxazole/referral

Relative (95%

CI)

Absolute

Failure rate

randomised

trials

serious¹

serious²

serious³

no serious imprecision

none

626/6107 (10.3%)

806/5316 (15.2%)

OR 0.67

(0.47 to

0.95)

45 fewer per 1000

(from 6 fewer to

74 fewer)

⊕ΟΟΟ

VERY

LOW

CRITICAL

Mortality on day 6

randomised

trials

serious¹

serious⁴

serious³

no serious imprecision

none

OR 0.4

(0.12 to

1.31)

⊕ΟΟΟ

VERY

LOW

¹Two studies were not blinded.

²I-squared=89%

³Developing countries.

⁴Heterogenity between studies.

Author(s): Leonie Venmans

Date: 2013-09-09

Question: Should oral amoxycillin / co-trimoxazole vs intravenous penicillin/amplicillin / intramuscular penicillin be used in pediatric patients with pneumonia?

Settings:

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

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Oral amoxycillin

/ cotrimoxazole

Intravenous penicillin/amplicillin /

intramuscular penicil-

lin

Relative (95%

CI)

Absolute

Failure rate

randomised

trials

serious¹

no serious inconsistency

serious²

serious³

none

279/1948 (14.3%)

297/1922 (15.5%)

RR 0.84

(0.56 to

1.24)

25 fewer per 1000 (from 68 fewer to

37 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

Cure rate

randomised

trials

serious⁴

no serious inconsistency⁵

serious⁶

serious³

none

RR 5.05

(1.19 to

21.33)

⊕ΟΟΟ

VERY

LOW

CRITICAL

Hospitalisation rate

randomised

serious¹

no serious

serious⁷

serious³

none

7/192

7/266

RR 1.13

3 more

⊕ΟΟΟ

CRITICAL

trials

inconsistency

(3.6%)

(2.6%)

(0.38 to

3.34)

per 1000 (from 16 fewer to

62 more)

VERY LOW

Mortality

randomised

trials

serious⁸

no serious inconsistency

serious⁹

no serious imprecision

none

1/1970 (0.05%)

11/1972 (0.56%)

RR 0.15

(0.03 to

0.87)

5 fewer per 1000

(from 1 fewer to 5 fewer)

⊕⊕ΟΟ LOW

CRITICAL

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

²Developing countries.

³Total 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.

⁴The two studies were unblinded.

⁵Not reported.

⁶One study was conducted in instanbul, the other in England.

⁷One study was conducted in Istanbul and one study in Gambia.

⁸The studies were not blinded.

⁹Two of the three studies were conducted in developing countries.

Author(s): Leonie Venmans Date: 2013-09-10

Question: Should short vs long course antibiotic therapy be used in patients aged 2-59 months with non-severe CAP?

Settings:

Bibliography: Haider BA, Lassi ZS, 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 Syst Rev 2011.

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Short

Long course antibiotic therapy

Relative (95% CI)

Absolute

Clinical cure rate

randomised

trials

serious¹

no serious inconsistency

very serious²

no serious imprecision

none

2582/2892 (89.3%)

2584/2871 (90%)

RR 0.99

(0.97 to

1.01)

9 fewer per

1000 (from

27 fewer to 9 more)

⊕ΟΟΟ

VERY

LOW

Treatment failure

randomised

trials

serious¹

no serious inconsistency

very serious²

no serious imprecision

none

310/2892 (10.7%)

287/2871 (10%)

RR 1.07

(0.92 to

1.25)

7 more per

1000 (from 8 fewer to 25 more)

⊕ΟΟΟ

VERY

LOW

¹Two 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.

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

Author(s): Leonie Venmans Date: 2013-09-10

Question: Should azithromycin and symptom-specific agents vs symptom-specific agents be used in children, aged 1-14 years with ARTI?

Settings:

Bibliography: Mulholland S, Gavranich JB, Gillies MB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. [Review][Update of Cochrane Database Syst Rev. 2010;(7):CD004875; PMID: 20614439]. Cochrane Database Syst Rev 2012;9:CD004875

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Azithromycin

and symptom-

specific agents

Symptomspecific agents

Relative (95% CI)

Absolute

Clinical cure at 1 month

randomised

trials

serious¹

no serious inconsistency²

very serious³

no serious imprecision

none

76/76 (100%)

88/114

(77.2%)

RR 1.29

(1.17 to

1.43)

224 more per 1000

(from 131 more to 332 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

Clinical cure at 6 months

randomised

trials

serious¹

no serious inconsistency²

very serious³

no serious imprecision

none

52/71

(73.2%)

61/109 (56%)

RR 1.31

(1.05 to

1.63)

173 more per 1000

(from 28 more to 353 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

¹Funded by Pfizer.

²One study only

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

Author(s): Leonie Venmans Date: 2013-09-12

Question: Should azithromycin vs amoxicillin/clavunalate be used in patients 0.5-16 yrs with CAP? Settings:

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Azithromycin

Amoxicillin/clavunalate

Relative

(95%

CI)

Absolute

Clinical cure at 15-19 days

randomised

trials

very

serious¹

no serious inconsistency²

serious³

serious⁴

none

84/125

(67.2%)

42/63

(66.7%)

RR 1.01

(0.81 to

1.25)

7 more per 1000

(from 127 fewer to

167 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

Clinical cure at 4 to 6 weeks

randomised

trials

very

serious¹

no serious inconsistency

serious³

serious⁵

none

97/114

(85.1%)

41/48

(85.4%)

RR 1.00

(0.87 to

1.15)

0 fewer per 1000

(from 111 fewer to

128 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

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

²One study only.

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

⁴Number of events <<300.

⁵No explanation was provided

Author(s): Leonie Venmans Date: 2013-09-12

Question: Should azithromycin vs amxoycillin be used in children aged 1 month to 14 yrs with classic CAP? Settings: ambulatory

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Azithromycin

Amxoycillin

Relative

(95% CI)

Absolute

Clinical cure at day 7

randomised

trials

serious¹

no serious inconsistency²

serious³

serious⁴

none

18/23

(78.3%)

14/24

(58.3%)

RR 1.42

(0.96 to

2.08)

245 more per

1000 (from 23 fewer to 630 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

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

²One study only.

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

⁴Number of evens <<300.

Author(s): Leonie Venmans Date: 2013-09-12

Question: Should azithromycin vs co-amoxyclavulanic acid be used in children with radiologically confirmed pneumonia?

Settings:

Quality assessment

No of patients

Effect

Quality

Importance

No of studies

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other conside-

rations

Azithromycin

Co amoxyclavulanic

acid

Relative (95% CI)

Absolute

Failure rate

randomised

trials

serious¹

no serious inconsistency²

very serious³

serious⁴

none

1/39

(2.6%)

2/49

(4.1%)

OR 0.62

(0.05 to

7.08)

15 fewer per 1000 (from 39 fewer to

191 more)

⊕ΟΟΟ

VERY

LOW

CRITICAL

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

²One study only.

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

⁴Total 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.

Author(s): Mariska Tuut Date: 2014-01-13

Question: Oseltamivir compared to placebo in kinderen met influenza pneumonie Settings:

Bibliography (systematic reviews): Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Spencer EA, Onakpoya IJ, Mahtani KR, Nunan D, Howick J, Heneghan CJ. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD008965. DOI: 10.1002/ 14651858.CD008965.pub4.

Quality assessment

№ of patients

Effect

Quality

Importance

№ of

studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

oseltamivir

placebo

Relative (95%

CI)

Absolute

(95% CI)

Verlichting symptomen (follow up: median 28 days)

randomised

trials

very serious

not serious ²

serious ³

serious ⁴

none

331

338

MD 29.4 lower

(47.04 lower to 11.76 lower)

⊕ΟΟΟ

VERY

LOW

MD – mean difference, RR – relative risk

Onduidelijke randomisatie, incomplete outcome assessment, inconsistente rapportage adverse events, selective reporting

Single study

Er is enige indirectheid in populatie; de studie gaat uit van 'verder gezonde kinderen' met koorts en een respiratoir symptoom; in de uitgangsvraag zijn we geïnteresseerd in kinderen met vastgestelde influenza pneumonie

Er is een statistisch significant effect, maar de grenzen van het 95%BI liggen ver uit elkaar. De klinische relevantie staat daarom ter discussie