| Comparison 2. Continuous oral Cephalexin versus antibiotics ‘as required’ | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Antibiotics ‘as required’ | Continuous oral Cephalexin, antibiotic prophylaxis | |||||
| Number of children from whom S aureus isolated at least once Respiratory cultures Follow-up: mean 1 years | 468 per 1000 | 145 per 1000 (79 to 266) | RR 0.31 (0.17 to 0.57) | 152 (Stutman 2002) | ⊕⊕⊕⊝ moderate1 | |
| Number of children from whom S aureus isolated at least once Respiratory cultures Follow-up: mean 2 years | 658 per 1000 | 217 per 1000 (145 to 336) | RR 0.33 (0.22 to 0.51) | 166 (Stutman 2002) | ⊕⊕⊕⊝ moderate2 | |
| Number of children from whom S aureus isolated at least once Respiratory cultures Follow-up: mean 3 years | 688 per 1000 | 289 per 1000 (199 to 406) | RR 0.42 (0.29 to 0.59) | 141 (Stutman 2002) | ⊕⊕⊕⊝ moderate3 | |
| Number of children from whom S aureus isolated at least once Respiratory cultures Follow-up: mean 4 years | 839 per 1000 | 352 per 1000 (252 to 495) | RR 0.42 (0.3 to 0.59) | 127 (Stutman 2002) | ⊕⊕⊕⊝ moderate4 | |
| Number of children from whom S aureus isolated at least once Respiratory cultures Follow-up: mean 5 years | 850 per 1000 | 348 per 1000 (238 to 501) | RR 0.41 (0.28 to 0.59) | 98 (Stutman 2002) | ⊕⊕⊝⊝ low5 | |
| Number of children from whom S aureus isolated at least once Respiratory cultures Follow-up: mean 6 years | 778 per 1000 | 280 per 1000 (140 to 552) | RR 0.36 (0.18 to 0.71) | 43 (Stutman 2002) | ⊕⊕⊝⊝ low6 | |
| Lung function FEV1 Follow-up: mean 6 years | The mean lung function in the control group was 115.8 | The mean lung function in the intervention groups was 2.3 lower (13.59 lower to 8.99 higher) | 119 (Stutman 2002) | ⊕⊝⊝⊝ very low7,8 | ||
| Any pulmonary exacerbations % Follow-up: mean 6 years | The mean number of pulmonary exacerbation in the control group was 66.8 | The mean number of pulmonary exacerbations in the intervention groups was 4.9 lower (22.24 lower to 12.44 higher) | 119 (Stutman 2002) | ⊕⊝⊝⊝ very low7,9 | ||
| Number of children requiring admission due to pulmonary exacerbations (annualised rates) not reported Follow-up: mean 6 years | 78 per 1000 | 74 per 1000 (20 to 260) | RR 0.94 (0.26 to 3.32) | 119 (Stutman 2002) | ⊕⊝⊝⊝ very low7,9 | |
| Adherence to treatment Parents self-report Follow-up: mean 6 years | The mean adherence to treatment in the control groups was 85 % | The mean adherence to treatment in the intervention groups was 5 higher (0 to 0 higher) | 119 (Stutman 2002) | ⊕⊕⊕⊝ moderate7,10 | ||
| Minor adverse events - generalised rash Parents self-report Follow-up: mean 6 years | The mean number of generalised rash events in the control group was 0.2 | The mean – number of generalised rash events in the intervention groups was 0.4 higher (0.07 lower to 0.87 higher) | 119 (Stutman 2002) | ⊕⊕⊕⊝ moderate7 | ||
| Minor adverse events - nappy rash Parents self-report Follow-up: mean 6 years | The mean number of nappy rash events in the control group was 3.1 | The mean – number of nappy rash events in the intervention groups was 0.9 higher (1.06 lower to 2.86 higher) | 119 (Stutman 2002) | ⊕⊕⊕⊝ moderate7 | ||
| Minor adverse events - increased stool frequency Parents self-report Follow-up: mean 6 years | The mean number of increased stool frequency events in the control group was 4.1 | The mean minor increased stool frequency events in the intervention groups was 0.2 higher (2.18 lower to 2.58 higher) | 119 (Stutman 2002) | ⊕⊕⊕⊝ moderate7 | ||
| Number of children from whom P
aeruginosa identified at least once Follow-up: mean 1 years | 312 per 1000 | 358 per 1000 (231 to 564) | RR 1.15 (0.74 to 1.81) | 152 (Stutman 2002) | ⊕⊝⊝⊝ very low1,9 | |
| Number of children from whom P
aeruginosa identified at least once Follow-up: mean 2 years | 506 per 1000 | 435 per 1000 (314 to 603) | RR 0.86 (0.62 to 1.19) | 166 (Stutman 2002) | ⊕⊕⊝⊝ low2,11 | |
| Number of children from whom P
aeruginosa identified at least once Follow-up: mean 3 years | 594 per 1000 | 582 per 1000 (445 to 772) | RR 0.98 (0.75 to 1.3) | 141 (Stutman 2002) | ⊕⊝⊝⊝ very low3,9 | |
| Number of children from whom P aeruginosa identified at least once Follow-up: mean 4 years | Study population | RR 1.1 (0.83 to 1.45) | 127 (Stutman 2002) | ⊕⊕⊝⊝ low4,11 | ||
| 589 per 1000 | 648 per 1000 (489 to 854) | |||||
| Moderate | ||||||
| 589 per 1000 | 648 per 1000 (489 to 854) | |||||
| Number of children from whom P
aeruginosa identified at least once Follow-up: mean 5 years | 550 per 1000 | 709 per 1000 (512 to 979) | RR 1.29 (0.93 to 1.78) | 98 (Stutman 2002) | ⊕⊝⊝⊝ very low5,11 | |
| Number of children from whom P
aeruginosa identified at least once Follow-up: mean 6 years | 667 per 1000 | 880 per 1000 (613 to 1000) | RR 1.32 (0.92 to 1.89) | 43 (Stutman 2002) | ⊕⊝⊝⊝ very low6,11 | |
The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Abbreviations: CI: confidence interval; FEV1: forced expiratory volume in 1 second; MD: mean difference; RR: risk ratio
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 1 for this outcome, as the losses to follow up are over 20% (n=152; N=209).
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 1 for this outcome, as the losses to follow up are over 20% (n=166; N=209).
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 1 for this outcome, as the losses to follow up are over 20% (n=141; N=209).
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 1 for this outcome, as the losses to follow up are over 20% (n=127; N=209).
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 2 for this outcome, as the losses to follow up are over 50% (n=98; N=209).
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 2 for this outcome, as the losses to follow up are over 50% (n=43; N=209).
This study was assessed by the Cochrane review Smyth 2014 as low risk of bias. However, the quality of the evidence was downgraded by 1 for this outcome, as the losses to follow up are over 20% (n=119; N=209).
The quality of the evidence was downgraded by 2, as the 95% CI crossed 2 clinical MIDs
The quality of the evidence was downgraded by 2, as the 95% CI crossed 2 default MIDs
Imprecision is not calculable with the data reported
The quality of the evidence was downgraded by 1, as the 95% CI crossed 1 default MID for dichotomous outcomes
From: 9, Pulmonary monitoring, assessment and management
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