Home > DARE Reviews > Antibiotics for the treatment of...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Antibiotics for the treatment of dysentery in children

BS Traa, CL Fischer Walker, M Munos, and RE Black.

Review published: 2010.

CRD summary

The authors concluded that there was strong evidence in favour of the continued use of the antibiotics ciprofloxacin, ceftriaxone and pivmecillinam (as recommended by the World Health Organization) to reduce morbidity and mortality in children with dysentery. The review had some methodological problems, but the authors' conclusions were based on the evidence and appear reasonable.

Authors' objectives

To review the evidence on the effectiveness of World Health Organization (WHO) recommended antibiotics (ciprofloxacin, ceftriaxone and pivmecillinam) for the treatment of dysentery in children.

Searching

PubMed, the Cochrane Library and WHO regional databases were searched from January 1990 to January 2009 for articles in any language. Search terms were reported.

Study selection

Studies of ciprofloxacin, ceftriaxone and pivmecillinam for the treatment of dysentery in children (up to 16 years old) were eligible for inclusion. Studies had to report on antibiotic effects on severe morbidity as observed by decreased blood in the stool or the effects of antibiotics on Shigella and/or Salmonella bacteria in stools.

The included randomised controlled trials (RCTs) compared ciprofloxacin (10 to 15mg/kg), ceftriaxone (50 to 100mg/kg) and pivmecillinam (40 to 50mg/kg) in children aged six months to 16 years with dysentery and/or bloody stools. Most trials were conducted in a clinical or hospital setting. Three outcome categories were considered: clinical failure, bacterial failure, and bacteriological relapse (definitions were detailed in the review).

The authors did not state how reviewers selected studies for the review.

Assessment of study quality

Quality assessment was undertaken using the CHERG (Child Health Epidemiology Reference Group) adaptation of the GRADE (Grades of Recommendation Assessment, Development and Evaluation) checklist (see Other publications of related interest).

The authors did not state how many authors performed the quality assessment.

Data extraction

Data were extracted on clinical failure rate, bacteriological failure rate and bacteriological relapse rate, and used the data to calculate relative risks (RRs) and 95% confidence intervals (CIs).

Methods of synthesis

The pooled relative risks, together with 95% confidence intervals, were calculated using the DerSimonian-Laird meta-analysis. A Mantel-Haenszel meta-analysis was also undertaken, but was not presented.

Results of the review

Eight moderate quality RCTs were included in the review.

After treatment with one of the three antibiotics, the pooled clinical failure rate was 0.1% (95% CI -0.2 to 0.5; eight RCTs), the pooled bacteriological failure rate was 0% (95% CI -0.1 to 0.1; four RCTs) and the pooled bacteriologic relapse rate was 0% (95% CI -0.1 to 0.1; five RCTs). In clinical terms, these rates suggested that in children with dysentery antibiotics clear the clinical signs of disease in 99.9% of cases (95% CI 99.5 to 100; eight RCTs), clear dysentery pathogens in 100% of cases (95% CI 99.9 to 100; four RCTs) and prevent bacteriologic relapse in 100% of cases (95% CI 99 to 100; five RCTs).

Authors' conclusions

There was strong evidence in favour of the continued use of the antibiotics ciprofloxacin, ceftriaxone and pivmecillinam, as recommended by WHO, to reduce morbidity and mortality in children with dysentery.

CRD commentary

Inclusion criteria for the review were broadly defined and several relevant databases were searched for articles in any language. There may have been the potential for publication bias, as the authors did not state whether unpublished studies were considered; publication bias was not assessed. The authors did not state how many reviewers performed study, data extraction and quality assessment, but did state that the CHERG guidelines were followed, which should have minimised error and bias in the review.

The quality assessment indicated the variable quality of the included trials, which the authors acknowledged. Trials were combined using meta-analysis; heterogeneity was explored but was not reported.

Overall, the review had some methodological problems, but the authors' conclusions were based on the evidence and appear reasonable.

Implications of the review for practice and research

Practice: The authors stated that the treatment of dysentery is critical to reducing dysentery deaths and should be easily accessible especially in areas where dysentery rates are high.

Research: The authors stated that future research into site-specific resistance might provide additional data and help refine recommendations for local and national planning.

Funding

The Bill and Melinda Gates Foundation, US Fund for UNICEF, grant number 43386; US National Institutes for Health, training grant number T32HD046405.

Bibliographic details

Traa BS, Fischer Walker CL, Munos M, Black RE. Antibiotics for the treatment of dysentery in children. International Journal of Epidemiology 2010; 39(Supplement 1): i70-i74. [PMC free article: PMC2845863] [PubMed: 20348130]

Other publications of related interest

Walker N, Fischer-Walker C, Bryce J, Bahl R, Cousens S, CHERG Review Groups on Intervention Effects. Standards for CHERG reviews of intervention effects on child survival. International journal of Epidemiology 2010;39(Supplement 1):i21-i31.

Indexing Status

Subject indexing assigned by NLM

MeSH

Amdinocillin Pivoxil /therapeutic use; Anti-Bacterial Agents /therapeutic use; Ceftriaxone /therapeutic use; Child, Preschool; Ciprofloxacin /therapeutic use; Dysentery /drug therapy /mortality; Dysentery, Bacillary /drug therapy /mortality; Female; Humans; Infant; Male; Randomized Controlled Trials as Topic; Salmonella Infections /drug therapy /mortality; Shigella dysenteriae; Treatment Outcome

AccessionNumber

12010003304

Database entry date

10/11/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20348130