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. 2023 Feb 9;2(2):CD013813.
doi: 10.1002/14651858.CD013813.pub2.

Antibiotics for chronic pulmonary infection in children with a neurodisability (neurodevelopmental disorder)

Affiliations

Antibiotics for chronic pulmonary infection in children with a neurodisability (neurodevelopmental disorder)

Juliane Rf Sanner et al. Cochrane Database Syst Rev. .

Abstract

Background: 'Neurodisability' refers to a group of conditions that result primarily from a neurological problem (e.g. cerebral palsy), neuromuscular problem (e.g. a muscular dystrophy) or developmental problems (e.g. developmental impairment, Down syndrome). Children and young people with these conditions may have similar problems with mobility, feeding and airway clearance. Chest and breathing problems (including pulmonary infections) are commonly experienced by children and young people with neurodisabilities and are often a cause for them requiring hospital care. For those who are unable to completely clear their airway of secretions, or have frequent infections, pulmonary infections may not be able to be completely eradicated and therefore become chronic. It is unclear what treatment is best for children and young people in this position.

Objectives: To assess the effectiveness and adverse effects of antibiotic treatment for chronic pulmonary infection in children and young people living with a neurodisability, including quality-of-life measures, effects on hospitalisation and healthcare contacts.

Search methods: We searched the Cochrane Airways Trials Register, Cochrane Acute Respiratory Infections Group Register of Trials (CARIGRT), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), OpenGrey (www.opengrey.eu) and three trials registries up to 8 February 2022. Additionally, we identified related systematic reviews through Epistemonikos.org (8 February 2022) and searched reference lists of these.

Selection criteria: All randomised controlled trials of antibiotic therapy for chronic pulmonary infection in children and young people up to the age of 18 living with a neurodisability were eligible.

Data collection and analysis: Two independent review authors screened results of the searches against predetermined inclusion criteria, resolving any discrepancies by discussion.

Main results: We identified a total of 1968 independent records through our searches, of which we assessed six full-text articles for eligibility. We identified one ongoing study as well as one related substudy but did not identify any completed studies eligible for inclusion in this systematic review.

Authors' conclusions: The findings of this systematic review highlight a lack of evidence in the antibiotic treatment of chronic pulmonary infection in children and young people up to the age of 18 living with a neurodisability. Further research examining this topic is therefore required.

PubMed Disclaimer

Conflict of interest statement

JS: salary part‐funded by NIHR Academic Clinical Fellowship.

KJ: none known.

JW: none known.

MNH: site Principal Investigator for the PARROT trial.

Figures

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PRISMA Flow Chart

Update of

References

References to studies excluded from this review

Gleason 2007 {published data only}
    1. Gleason PP, Shaughnessy AF. Telithromycin (Ketek) for treatment of community-acquired pneumonia. American Family Physician 2007;76(12):1857-8.
Greenberg 1974 {published data only}
    1. Greenberg M, Edmonds J. Chronic respiratory problems in neuromyopathic disorders: their nature and management. Pediatric Clinics of North America 1974;21(4):927-34. [DOI: 10.1016/s0031-3955(16)33068-1] - DOI - PubMed
Nydahl‐Persson 1995 {published data only}
    1. K Nydahl-Persson, A Petterson, Fasth A. A prospective, double-blind, placebo-controlled trial of iv immunoglobulin and trimethoprim-sulfamethoxazole in children with recurrent respiratory tract infections. Acta Paediatrica 1995;84(9):1007-9. [DOI: 10.1111/j.1651-2227.1995.tb13816.x] - DOI - PubMed
Reinert 2004 {published data only}
    1. Reinert R. Clinical efficacy of ketolides in the treatment of respiratory tract infections. Journal of Antimicrobial Chemotherapy 2004;53:918–27. [DOI: 10.1093/jac/dkh169] - DOI - PubMed

References to ongoing studies

ACTRN12621001486819 {published data only}
    1. ACTRN12621001486819. Effect of prophylactic azithromycin on chest infections in children with neurological and neuromuscular impairment [Randomised, triple blinded, placebo trial comparing 26 weeks of azithromycin to placebo in children with neurological/neuromuscular impairment to reduce the risk of lower respiratory tract infection]. trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12621001486819 (first received 1 November 2021). [ACTRN: ACTRN12621001486819]
ISRCTN71955516 {published data only}ACTRN12619001597189ISRCTN71955516
    1. ISRCTN71955516. Prophylactic antibiotics to prevent chest infections in children with neurological impairment [Joint UK and Australia multicentre, randomised, double-blind, placebo-controlled pragmatic trial comparing 52 weeks of azithromycin to placebo in children with neurological impairment at risk of lower respiratory tract infection (the PARROT trial)]. trialsearch.who.int/Trial2.aspx?TrialID=ISRCTN71955516 (first received 22 April 2020). [DOI: ]

Additional references

Baars 2005
    1. Baars RM, Atherton C, Koopman HM, Bullinger M, Power M, DISABKIDS group. The European DISABKIDS project: development of seven condition-specific modules to measure health related quality of life in children and adolescents. Health and Quality of Life Outcomes 2005;3:70. [DOI: 10.1186/1477-7525-3-70] - DOI - PMC - PubMed
Blackmore 2019
    1. Blackmore AM, Gibson N, Cooper MS, Langdon K, Moshovis L, Wilson AC. Interventions for management of respiratory disease in young people with cerebral palsy: a systematic review. Child: Care, Health and Development 2019;45(5):754-71. - PubMed
Boel 2019
    1. Boel L, Pernet K, Toussaint M, Ides K, Leemans G, Haan J, et al. Respiratory morbidity in children with cerebral palsy: an overview. Developmental Medicine and Child Neurology 2019;61(6):646-53. - PubMed
Cassini 2019
    1. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infectious Diseases 2019;19(1):56-66. - PMC - PubMed
Chang 2015
    1. Chang B, Nariai A, Sekizuka T, Akeda Y, Kuroda M, Oishi K, et al. Capsule switching and antimicrobial resistance acquired during repeated Streptococcus pneumoniae pneumonia episodes. Journal of Clinical Microbiology 2015;53(10):3318-24. [DOI: 10.1128/JCM.01222-15] - DOI - PMC - PubMed
Cochrane Airways 2019
    1. Cochrane Airways Trials Register. airways.cochrane.org/trials-register (accessed 7 May 2019).
Covidence [Computer program]
    1. Covidence. Version accessed 25 October 2019. Melbourne, Australia: Veritas Health Innovation. Available at www.covidence.org.
Cunha 2001
    1. Cuhna BA. Antibiotic side effects. Medical Clinics of North America 2001;85:149-85. - PubMed
Davis 2013
    1. Davis E, Mackinnon A, Davern M, Boyd R, Bohanna I, Waters E, et al. Description and psychometric properties of the CP QOL-Teen: A quality of life questionnaire for adolescents with cerebral palsy. Research in Developmental Disabilities 2013;34(1):344-52. [DOI: 10.1016/j.ridd.2012.08.018] - DOI - PubMed
Dohna‐Schwake 2006
    1. Dohna-Schwake C, Ragette R, Teschler H, Voit T, Mellies U. Predictors of severe chest infections in pediatric neuromuscular disorders. Neuromuscular Disorders 2006;16(5):325-8. [DOI: 10.1016/j.nmd.2006.02.003] - DOI - PubMed
Elbourne 2002
    1. Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta-analyses involving cross-over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140-9. [DOI: 10.1093/ije/31.1.140] - DOI - PubMed
Emerson 2012
    1. Emerson E. Deprivation, ethnicity and the prevalence of intellectual and developmental disabilities. Journal of Epidemiology and Community Health 2012;66(3):218-24. [DOI: 10.1136/jech.2010.111773] - DOI - PubMed
Family Resources Survey 2016
    1. Department for Work and Pensions, UK. Family resources survey: financial year 2016/17. www.gov.uk/government/statistics/family-resources-survey-financial-year-... (accessed prior to 29 November 2020).
Fitzgerald 2009
    1. Fitzgerald DA, Follett J, Van Asperen PP. Assessing and managing lung disease and sleep disordered breathing in children with cerebral palsy. Paediatric Respiratory Reviews 2009;10(1):18-24. - PubMed
Gleckman 2000
    1. Gleckman RA, Czachor JS. Antibiotic side effects. Seminars in Respiratory and Critical Care Medicine 2000;21(1):61-70. - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed 25 October 2019. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015. Available at gradepro.org.
Higgins 2017
    1. Higgins JP, Altman DG, Sterne JA, editor(s). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.2.0 (updated June 2017). Cochrane, 2017. Available from www.training.cochrane.org/handbook/archive/v5.2.
Higgins 2020
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook. - PMC - PubMed
Hum 2019
    1. Hum S, Shaikh K, Musa S, Shaikh N. Adverse events of antibiotics used to treat acute otitis media in children: a systematic meta-analysis. Journal of Pediatrics 2019;215:139-43.e7. [DOI: 10.1016/j.jpeds.2019.08.043] - DOI - PubMed
Hurley 2015
    1. Hurley M, Vyas H. Respiratory problems in children with neurodisability. Paediatrics and Child Health 2015;25(10):463-6.
Kansra 2016
    1. Kansra S, Ugonna K. Fifteen-minute consultation: approach to management of respiratory problems in children with neurodisability. Archives of Disease in Childhood Education and Practice Edition 2016;101(5):226-31. - PubMed
Kohanski 2010
    1. Kohanski MA, Dwyer DJ, Collins JJ. How antibiotics kill bacteria: from targets to networks. Nature Reviews Microbiology 2010;8(6):423-35. - PMC - PubMed
Marshall 2018
    1. Marshall IJ, Noel-Storr AH, Kuiper J, Thomas J, Wallace BC. Machine learning for identifying randomized controlled trials: an evaluation and practitioner’s guide. Research Synthesis Methods 2018;9(4):602-14. - PMC - PubMed
McDonald 2017
    1. McDonald S, Noel-Storr AH, Thomas J. Harnessing the efficiencies of machine learning and Cochrane Crowd to identify randomised trials for individual Cochrane reviews. In: Global Evidence Summit; 2017 September 13-16; Cape Town, South Africa. 2017.
McGowan 2016
    1. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of Clinical Epidemiology 2016;75:40-6. [DOI: 10.1016/j.jclinepi.2016.01.021] - DOI - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine 2009;6(7):e1000097. [DOI: 10.1371/journal.pmed.1000097] - DOI - PMC - PubMed
Morris 2013
    1. Morris C, Janssens A, Tomlinson R, Williams J, Logan S. Towards a definition of neurodisability: a Delphi survey. Developmental Medicine and Child Neurology 2013;55(12):1103-8. [DOI: 10.1111/dmcn.12218] - DOI - PubMed
NCEPOD 2018
    1. National Confidential Enquiry into Patient Outcome and Death. Each and every need - a review of the quality of care provided to patients aged 0-25 years old with chronic neurodisability, using the cerebral palsies as examples of chronic neurodisabling conditions; 2018. www.ncepod.org.uk/2018report1/downloads/EachAndEveryNeed_FullReport.pdf.
Noel‐Storr 2018
    1. Noel-Storr AH, Project Transform team. Cochrane Crowd: new ways of working together to produce health evidence. In: Evidence Live; 2018 June 18-20; Oxford, UK. 2018.
Onakpoya 2015
    1. Onakpoya I, Hayward G, Heneghan C. Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No: CD011530. [DOI: 10.1002/14651858.CD011530.pub2] - DOI - PMC - PubMed
Petrou 2013
    1. Petrou S, Johnson S, Wolke D, Marlow N. The association between neurodevelopmental disability and economic outcomes during mid-childhood. Child: Care, Health and Development 2013;39(3):345-57. [DOI: 10.1111/j.1365-2214.2012.01368.x] - DOI - PubMed
Plioplys 2011
    1. Plioplys AV, Kasnicka I. Nebulized tobramycin: prevention of pneumonias in patients with severe cerebral palsy. Journal of Pediatric Rehabilitation Medicine 2011;4(2):155-8. [DOI: 10.3233/PRM-2011-0168] - DOI - PubMed
Proesmans 2016
    1. Proesmans M. Respiratory illness in children with disability: a serious problem? Breathe 2016;12(4):e97-e103. - PMC - PubMed
Review Manager 2020 [Computer program]
    1. Review Manager 5 (RevMan 5). Version 5.4. Copenhagen: The Cochrane Collaboration, 2020.
Thomas 2017
    1. Thomas J, Noel-Storr AH, Marshall I, Wallace B, McDonald S, Mavergames C, et al. Living systematic review network. Living systematic reviews: 2. Combining human and machine effort. Journal of Clinical Epidemiology 2017;91:31-7. - PubMed
Trinick 2015
    1. Trinick RE, Bunni L, Thorburn K, Hackett AP, Dalzell M, McNamara PS. An observational study examining the relationship between respiratory symptoms, airway inflammation and bacteriology in children with severe neurodisability. PLOS one 2015;10(4):e0124627. [DOI: 10.1371/journal.pone.0124627] - DOI - PMC - PubMed
Waters 2006
    1. Waters E, Davis E, Mackinnon A, Boyd R, Graham HK, Kai Lo S, et al. Psychometric properties of the quality of life questionnaire for children with CP. Developmental Medicine and Child Neurology 2006;49(1):49-55. [DOI: 10.1017/S0012162207000126.x] - DOI - PubMed

References to other published versions of this review

Sanner 2020
    1. Sanner JR, Jain K, Williams J, Smyth AR, Hurley MN. Antibiotics for chronic pulmonary infection in children with a neurodisability (neurodevelopmental disorder). Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No: CD013813. [DOI: 10.1002/14651858.CD013813] - DOI - PMC - PubMed

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