title: Antibiotic and systemic therapies for pneumonia in human immunodeficiency virus (HIV)-infected and HIV-exposed children.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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systemic therapy for pneumonia in HIV-infected and HIV-exposed, uninfected children, we searched for published and unpublished studies from 11 databases including MedLine, Global Health Database, Biological Abstracts (BIOSIS), the Cochrane Central Register of Controlled Trials, the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.
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa. waruneep@gmail.com
authors.forename: Warunee
authors.initials: W
authors.lastname: Punpanich
authors.forename: Michelle
authors.initials: M
authors.lastname: Groome
authors.forename: Lulu
authors.initials: L
authors.lastname: Muhe
authors.forename: Shamim A
authors.initials: SA
authors.lastname: Qazi
authors.forename: Shabir Ahmed
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005060:Europe; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007843:Latin America; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents