Benefits and risks Antibiotic treatment for non-severe pneumonia with wheeze

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6.2 Antibiotic treatment for non-severe pneumonia with no wheeze

a Children with non-severe pneumonia i.e. fast breathing with no chest indrawing or danger sign should be treated with oral amoxicillin. he exception is in patients with HIV. — With low HIV prevalence, give amoxicillin of at least 40mgkgdose twice daily for 3 days. — With high HIV prevalence, give amoxicillin of at least 40mgkgdose twice daily for 5 days. Weak recommendation, moderate quality evidence b Children with non-severe pneumonia who fail on the irst line treatment with amoxicillin should have the option of referral where there is no appropriate second line treatment. Weak recommendation, expert opinion his recommendation was made based on mostly RCTs that were conducted in Asia, and more likely in low HIV prevalence settings. Amoxicillin was recommended based on values and preferences since dispersible amoxicillin is becoming more available and the cost is decreasing. he panel also clariied that the moderate quality evidence relates to comparisons of the duration of the two antibiotic regimens of amoxicillin for 3 versus 5 days which showed that they were no diferent in terms of cure and clinical failure rates.

6.2.1 Evidence and summary of findings

Randomized trials have not shown signiicant diferences in the efectiveness of diferent oral antibiotics for the treatment of non-severe pneumonia in children see GRADE table A7.9 . Amoxicillin and co-trimoxazole are the most widely available antibiotics. Amoxicillin has been shown to be more efective than co-trimoxazole for treating severe pneumonia in one trial. here is no signiicant diference between short duration 3 day and long duration 5 day antibiotic therapy for non-severe pneumonia in low HIV prevalence settings. A systematic review [Sajwani, 2010] identiied trials comparing diferent oral antibiotics and short-course 3 days versus long-course 5 days oral antibiotics. Choice of antibiotic hree studies compared oral co-trimoxazole with oral amoxicillin. he studies involved 3952 children 2067 in the co-trimoxazole group and 1885 in the amoxicillin group between 2 months and 59 months of age with WHO-deined non-severe pneumonia. One study [Strauss, 1998] also included a subset of children with severe pneumonia. Two studies were double blinded RCTs, with adequate allocation concealment. he third study was an open-label and cluster-randomized. Primary outcomes were clinical cure and failure. Comparing amoxicillin to co-trimoxazole, pooled analysis shows no diference in clinical failure RR 1.09, 95 CI 0.93 to 1.27; 3 studies nor cure rate RR 0.99, 95 CI 0.96 to 1.01; 2 studies.