Kabra S K, Lodha R, Pandey R M
All India Institute of Medical Sciences, Department of Pediatrics, Ansari Nagar, New Delhi, India 110 029.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004874. doi: 10.1002/14651858.CD004874.pub2.
Pneumonia is the leading cause of mortality in children. In developing countries, pneumonia is usually caused by bacterial pathogens. The early administration of empirical antibiotics improves the patients' clinical outcomes. There are currently no systematic reviews of clinical trials on this subject.
To identify effective antibiotic drug therapy for community acquired pneumonia (CAP) in children by comparing various antibiotics.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005), MEDLINE (OVID) (1966 to January 2006) and EMBASE (WebSPIRS) (1990 to September 2005). There were no language restrictions.
Randomized controlled trials (RCTs) in children of either sex, which compared at least two antibiotics for CAP in hospital or ambulatory settings.
Data from full articles of selected studies were independently extracted by two authors.
The review of these studies suggests that for treatment of pneumonia, co-trimoxazole is inferior in efficacy to both amoxycillin (failure rates odds ratio (OR) 1.33; 95% CI 1.05 to 1.67) and procaine penicillin (cure rates OR 2.64; 95% CI 1.57 to 4.45). Penicillin in conjunction with gentamycin was better than chloramphenicol alone (re-hospitalization rates OR 1.61; 95% CI 1.02 to 2.55). Co-amoxyclavulanic acid was better than amoxycillin alone (cure rates OR 10.44; 95% CI 2.85 to 38.21). There was no differences between injectable penicillin and oral amoxycillin (failure rates OR 1.03; 95% CI 0.81 to 1.31); azithromycin and erythromycin (cure rates OR 1.17; 95% CI 0.70 to 1.95); cefpodoxime and amoxycillin (cure rates OR 0.69; 95% CI 0.18 to 2.60); or azithromycin and co-amoxyclavulanic acid (cure rates OR 1.02; 95% CI 0.54 to 1.95, failure rates OR 1.42; 95% CI 0.43 to 4.66).
AUTHORS' CONCLUSIONS: There were many studies each investigating multiple antibiotics with different methodologies. For treatment of ambulatory patients with CAP, amoxycillin was better than co-trimoxazole; there was no difference between azithromycin and erythromycin, or between cefpodoxime and co-amoxyclavulanic acid. For hospitalized patients, procaine penicillin was better than co-trimoxazole; and the combination of penicillin and gentamycin was better than chloramphenicol alone. Injectable penicillin and oral amoxycillin had similar failure rates. For the rest of the antibiotics there were only single studies available. There is a need for more studies with large patient populations and similar methodologies in order to compare newer antibiotics.
肺炎是儿童死亡的主要原因。在发展中国家，肺炎通常由细菌病原体引起。早期使用经验性抗生素可改善患者的临床结局。目前尚无关于该主题的临床试验系统评价。
通过比较各种抗生素，确定治疗儿童社区获得性肺炎（CAP）的有效抗生素药物疗法。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》，2005年第4期）、MEDLINE（OVID）（1966年至2006年1月）和EMBASE（WebSPIRS）（1990年至2005年9月）。无语言限制。
纳入针对任何性别的儿童进行的随机对照试验（RCT），这些试验在医院或门诊环境中比较了至少两种用于治疗CAP的抗生素。
两名作者独立提取所选研究全文中的数据。
对这些研究的综述表明，对于肺炎治疗，复方新诺明在疗效上低于阿莫西林（失败率比值比（OR）1.33；95%置信区间1.05至1.67）和普鲁卡因青霉素（治愈率OR 2.64；95%置信区间1.57至4.45）。青霉素联合庆大霉素优于单用氯霉素（再次住院率OR 1.61；95%置信区间1.02至2.55）。阿莫西林克拉维酸优于单用阿莫西林（治愈率OR 10.44；95%置信区间2.85至38.21）。注射用青霉素和口服阿莫西林之间无差异（失败率OR 1.03；95%置信区间0.81至1.31）；阿奇霉素和红霉素之间无差异（治愈率OR 1.17；95%置信区间0.70至1.95）；头孢泊肟酯和阿莫西林之间无差异（治愈率OR 0.69；95%置信区间0.18至2.60）；或阿奇霉素和阿莫西林克拉维酸之间无差异（治愈率OR 1.02；95%置信区间0.54至1.95，失败率OR 1.42；95%置信区间0.43至4.66）。
有许多研究分别采用不同方法对多种抗生素进行了研究。对于门诊CAP患者的治疗，阿莫西林优于复方新诺明；阿奇霉素和红霉素之间、头孢泊肟酯和阿莫西林克拉维酸之间无差异。对于住院患者，普鲁卡因青霉素优于复方新诺明；青霉素和庆大霉素联合使用优于单用氯霉素。注射用青霉素和口服阿莫西林的失败率相似。对于其余抗生素，仅有单项研究。需要开展更多具有大样本量且方法相似的研究，以便比较新型抗生素。
