Limited Evidence on the Management of Respiratory Tract Infections in Down's Syndrome: A Systematic Review.
To systematically review the effectiveness of preventative and therapeutic interventions for respiratory tract infections (RTIs) in people with Down's syndrome.



Databases were searched for any published and ongoing studies of respiratory tract diseases in children and adults with Down's syndrome. These databases were searched for controlled trials, cohort studies and controlled before-after studies. Trial registries were searched for ongoing studies. Initially, all study types were included to provide a broad overview of the existing evidence base. However, those with a critical risk of bias were excluded using the Cochrane Risk of Bias tool.



A total of 13,575 records were identified from which 5 studies fulfilled the eligibility criteria and 3 fulfilled our criteria for data extraction. One randomized controlled trial of moderate risk of bias compared zinc therapy with placebo. Outcome data were only reported for 50 (78%) children who presented with extreme symptoms; no benefit of zinc therapy was found. One non-randomized controlled trial with serious risk of bias included 26 children and compared pidotimod (an immunostimulant) with no treatment; pidotimod was associated with fewer upper RTI recurrences compared with no treatment (1.43 vs. 3.82). A prospective cohort study with moderate risk of bias compared 532 palivizumab treated children with 233 untreated children and found that children treated with palivizumab had fewer respiratory syncytial virus-related hospitalization (23 untreated and 8 treated), but the same number of overall RTI-related hospitalizations (73 untreated and 74 treated) in the first 2 years of life.



The evidence base for the management of RTIs in people with Down's syndrome is incomplete; current studies included children only and carry a moderate to serious risk of bias. Methodologic rigorous studies are warranted to guide clinicians in how best to prevent and treat RTIs in children with Down's syndrome.
From the *Institute of Child Health, University College London; †Guy's King's & St Thomas' School of Medical Education, King's College London, London, United Kingdom; ‡Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; §UCL Farr Institute of Health Informatics, University College London; ¶Division of Health and Social Care Research, King's College London; and ‖evidENT, Ear Institute, University College London, London, United Kingdom.
Logan
L
Manikam
Kate
K
Reed
Roderick P
RP
Venekamp
Andrew
A
Hayward
Peter
P
Littlejohns
Anne
A
Schilder
Monica
M
Lakhanpaul
D000890:Anti-Infective Agents / Q000627:therapeutic use; D015982:Bias; D002986:Clinical Trials as Topic; D004314:Down Syndrome / Q000150:complications*; D006801:Humans; D000069455:Palivizumab / Q000627:therapeutic use; D011761:Pyrrolidonecarboxylic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000150:complications* / Q000188:drug therapy* / Q000517:prevention & control; D053778:Thiazolidines / Q000627:therapeutic use; D015032:Zinc / Q000627:therapeutic use
D000890:Anti-Infective Agents; D053778:Thiazolidines; C064893:pidotimod; D000069455:Palivizumab; D015032:Zinc; D011761:Pyrrolidonecarboxylic Acid