Antibiotic and systemic therapies for pneumonia in human immunodeficiency virus (HIV)-infected and HIV-exposed children

Warunee Punpanich; Michelle Groome; Lulu Muhe; Shamim A Qazi; Shabir Ahmed Madhi

doi:10.3855/jidc.2004

Antibiotic and systemic therapies for pneumonia in human immunodeficiency virus (HIV)-infected and HIV-exposed children

Authors

Warunee Punpanich Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand, South Africa
Michelle Groome Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand, South Africa
Lulu Muhe Departments of Child and Adolescent Health and Development and HIV, World Health Organization, Geneva, Switzerland
Shamim A Qazi Departments of Child and Adolescent Health and Development and HIV, World Health Organization, Geneva, Switzerland
Shabir Ahmed Madhi Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand, South Africa

DOI:

https://doi.org/10.3855/jidc.2004

Keywords:

HIV, pneumonia, children, opportunistic infection, meta-analysis, antimicrobial therapy, adjunctive therapy

Abstract

Introduction: Pneumonia is the leading cause of mortality in both human immunodeficiency virus (HIV)-infected and HIV-exposed children. Administration of appropriate empirical antimicrobial and/or adjunctive systemic therapies may improve clinical outcomes.

Methodology: To identify effective antimicrobial and/or adjunctive systemic therapy for pneumonia in HIV-infected and HIV-exposed, uninfected children, we searched for published and unpublished studies from 11 databases including MedLine, Global Health Database, Biological Abstracts (BIOSIS), the Cochrane Central Register of Controlled Trials, the World Health Organization Library Information System, AIDSLine, and the System for Information on Grey Literature in Europe, along with additional four regional databases including African Index Medicus, Latin America and Caribbean, Eastern Mediterranean, and South-East Asian databases. Data from full articles of selected studies were independently extracted by two reviewers.

Results: No a priori planned randomized controlled trials (RCT) were identified, only subgroup analyses of an RCT comparing oral amoxicillin versus parenteral penicillin for severe pneumonia in children. HIV-infected children had significantly higher treatment failure rates compared to their uninfected counterparts. An RCT study investigating adjunctive corticosteroid therapy for Pneumocystis jiroveci pneumonia (PCP) failed to identify a statistically significant reduction in mortality in the treatment group with a relative risk of 0.57 (95% CI 0.30-1.07). A before-after observational study showed substantial beneficial effect of corticosteroid treatment in reducing mortality among HIV-infected children with PCP.

Conclusions: Insufficient evidence exists to identify effective antimicrobial treatment regimens for HIV-associated pneumonia in paediatric populations or confirm the beneficial effect of corticosteroid treatment for HIV-infected children with PCP.

Author Biography

Warunee Punpanich, Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand, South Africa

Assistant Professor of Pediatrics, College of Medicine, Rangsit University

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Published

2011-09-26

How to Cite

Punpanich W, Groome M, Muhe L, Qazi SA, Madhi SA (2011) Antibiotic and systemic therapies for pneumonia in human immunodeficiency virus (HIV)-infected and HIV-exposed children. J Infect Dev Ctries 6:109–119. doi: 10.3855/jidc.2004

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Issue

Vol. 6 No. 02: February 2012

Section

Reviews

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