title: Oral Antibiotics for Community acquired Pneumonia with Chest indrawing in Children Aged Below Five Years: A Systematic Review.
abstract: OBJECTIVE
  To determine the efficacy of oral antibiotics in under-five children with pneumonia and chest indrawing.
  
  
  METHODS
  We included controlled clinical trials (randomized or quasi randomized) that compared the efficacy of oral antibiotics versus parenteral antibiotics for treatment of community acquired pneumonia with chest indrawing (severe pneumonia as defined by the World Health Organizations guidelines) in children below 60 months of age. Data were extracted and managed using RevMan software. Main outcome variables were: treatment failure rate, relapse rate, death rate, need for hospitalization, and severe adverse effects.
  
  
  RESULTS
  We identified four randomized controlled trials involving 4400 children who were diagnosed to have severe pneumonia but were feeding well and not hypoxic. Baseline characteristics of children in the two treatment arms (oral and parenteral antibiotics) were similar. In two studies, oral antibiotics were administered on an ambulatory basis, while in two, oral antibiotics were used in hospitalized children. Failure rate in children receiving oral antibiotics was 13% (288/2208) while that in children receiving parenteral antibiotics was 13.8% (302/2183) (OR 0.93; 95% CI 0.78, 1.11). Failure rates were not affected by the type of oral antibiotic, or presence of wheeze. Relapse rates, hospitalization or serious adverse events were similar in the two groups.
  
  
  CONCLUSIONS
  Children with tachypnea with chest indrawing without signs and symptoms of very severe pneumonia may be treated with oral antibiotics.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr SK Kabra, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India. skkabra@hotmail.com.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
authors.forename: Shivani
authors.initials: S
authors.lastname: Randev
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Kabra
mesh_terms: D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin