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Drug Design, Development and Therapy 2018Childhood reactive airway diseases (RADs) are concerning problems in children's airways and may be preceded by bronchiolitis and may progress to childhood asthma. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
Childhood reactive airway diseases (RADs) are concerning problems in children's airways and may be preceded by bronchiolitis and may progress to childhood asthma. The severity of the disease is indicated by deterioration in pulmonary functions, increased usage of rescue medications, and recurrent wheezing episodes. Macrolides have both antimicrobial and anti-inflammatory functions and have been used as adjunctive therapy in childhood RADs.
PATIENTS AND METHODS
We conducted a meta-analysis to evaluate the effect of macrolides in children with RAD. Literature searches were systematically conducted using an electronic database from inception to August 2018. The Cochrane review risk of bias assessment tool was used to assess the quality of each randomized controlled trial.
RESULTS
Sixteen randomized controlled trials comprising 1,415 participants were investigated in this meta-analysis. Children treated with macrolide therapy showed significantly better pulmonary functions in both forced expiratory volume in one second (% predicted) (difference in means=-9.77, 95% CI=-14.18 to -5.35, <0.001; =0%) and forced expiratory flow 25-75 (% predicted) (difference in means=-14.14, 95% CI=-26.11 to -2.18, =0.02; =29.56%). In addition, the short-acting β-agonist usage days and recurrent wheezing risk were significantly lowered in children with macrolide treatment (standardized difference in means=-0.34, 95% CI=-0.59 to -0.09, =0.007, =27.05% and standardized difference in means=-0.53, 95% CI=-0.81 to -0.26, <0.001, =0%, respectively). Furthermore, the growth of from nasal swabs was less in children treated with macrolides (odds ratio=0.19, 95% CI=0.11-0.35, <0.001). Children who took macrolides had a lower risk of adverse events (risk ratio=0.83, 95% CI=0.70-0.98, =0.024, =0%).
CONCLUSION
This current meta-analysis suggested that adjunctive therapy with macrolides is safe and effective for achieving better outcomes in childhood RAD.
Topics: Anti-Bacterial Agents; Asthma; Bronchiolitis; Child; Humans; Macrolides; Randomized Controlled Trials as Topic; Respiratory Sounds
PubMed: 30510399
DOI: 10.2147/DDDT.S183527 -
Microbiome Nov 2018Otitis media (OM) imposes a great burden of disease in indigenous populations around the world, despite a variety of treatment and prevention programs. Improved...
The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media.
BACKGROUND
Otitis media (OM) imposes a great burden of disease in indigenous populations around the world, despite a variety of treatment and prevention programs. Improved understanding of the pathogenesis of OM in indigenous populations is required to advance treatment and reduce prevalence. We conducted a systematic review of the literature exploring the upper airway and middle ear microbiota in relation to OM in indigenous children.
METHODS
Papers targeting microbiota in relation to OM in children < 18 years indigenous to Australia, New Zealand, North America, and Greenland were sought. MEDLINE, CINAHL, EMBASE, Cochrane Library, and Informit databases were searched using key words. Two independent reviewers screened titles, abstracts, and then full-text papers against inclusion criteria according to PRISMA guidelines.
RESULTS
Twenty-five papers considering indigenous Australian, Alaskan, and Greenlandic children were included. There were high rates of nasopharyngeal colonization with the three main otopathogens (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) in indigenous children with OM. Middle ear samples had lower rates of otopathogen detection, although detection rates increased when molecular methods were used. Pseudomonas aeruginosa and Staphylococcus aureus were commonly detected in middle ear discharge of children with chronic suppurative OM. There was a significant heterogeneity between studies, particularly in microbiological methods, which were largely limited to culture-based detection of the main otopathogens.
CONCLUSIONS
There are high rates of otopathogen colonization in indigenous children with OM. Chronic suppurative OM appears to be associated with a different microbial profile. Beyond the main otopathogens, the data are limited. Further research is required to explore the entire upper respiratory tract/middle ear microbiota in relation to OM, with the inclusion of healthy indigenous peers as controls.
Topics: Adolescent; Australia; Child; Child, Preschool; Ear, Middle; Greenland; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Microbiota; Moraxella catarrhalis; Nasopharynx; New Zealand; North America; Otitis Media; Population Groups; Streptococcus pneumoniae
PubMed: 30396360
DOI: 10.1186/s40168-018-0577-2 -
PloS One 2016Otitis media (OM) is amongst the most common childhood diseases and is associated with multiple microbial pathogens within the middle ear. Global and temporal monitoring... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Otitis media (OM) is amongst the most common childhood diseases and is associated with multiple microbial pathogens within the middle ear. Global and temporal monitoring of predominant bacterial pathogens is important to inform new treatment strategies, vaccine development and to monitor the impact of vaccine implementation to improve progress toward global OM prevention.
METHODS
A systematic review of published reports of microbiology of acute otitis media (AOM) and otitis media with effusion (OME) from January, 1970 to August 2014, was performed using PubMed databases.
RESULTS
This review confirmed that Streptococcus pneumoniae and Haemophilus influenzae, remain the predominant bacterial pathogens, with S. pneumoniae the predominant bacterium in the majority reports from AOM patients. In contrast, H. influenzae was the predominant bacterium for patients experiencing chronic OME, recurrent AOM and AOM with treatment failure. This result was consistent, even where improved detection sensitivity from the use of polymerase chain reaction (PCR) rather than bacterial culture was conducted. On average, PCR analyses increased the frequency of detection of S. pneumoniae and H. influenzae 3.2 fold compared to culture, whilst Moraxella catarrhalis was 4.5 times more frequently identified by PCR. Molecular methods can also improve monitoring of regional changes in the serotypes and identification frequency of S. pneumoniae and H. influenzae over time or after vaccine implementation, such as after introduction of the 7-valent pneumococcal conjugate vaccine.
CONCLUSIONS
Globally, S. pneumoniae and H. influenzae remain the predominant otopathogens associated with OM as identified through bacterial culture; however, molecular methods continue to improve the frequency and accuracy of detection of individual serotypes. Ongoing monitoring with appropriate detection methods for OM pathogens can support development of improved vaccines to provide protection from the complex combination of otopathogens within the middle ear, ultimately aiming to reduce the risk of chronic and recurrent OM in vulnerable populations.
Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Child; Child, Preschool; Global Health; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Otitis Media; Otitis Media with Effusion; Polymerase Chain Reaction
PubMed: 26953891
DOI: 10.1371/journal.pone.0150949 -
PloS One 2014Infection with Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide, especially in low income countries where pneumococcal conjugate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infection with Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide, especially in low income countries where pneumococcal conjugate vaccines (PCVs) are still underused. In countries where PCVs have been introduced, much of their efficacy has resulted from their impact on nasopharyngeal carriage in vaccinated children. Understanding the epidemiology of carriage for S. pneumoniae and other common respiratory bacteria in developing countries is crucial for implementing appropriate vaccination strategies and evaluating their impact.
METHODS AND FINDINGS
We have systematically reviewed published studies reporting nasopharyngeal or oropharyngeal carriage of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Neisseria meningitidis in children and adults in low and lower-middle income countries. Studies reporting pneumococcal carriage for healthy children <5 years of age were selected for a meta-analysis. The prevalences of carriage for S. pneumoniae, H. influenzae, and M. catarrhalis were generally higher in low income than in lower-middle income countries and were higher in young children than in adults. The prevalence of S. aureus was high in neonates. Meta-analysis of data from young children before the introduction of PCVs showed a pooled prevalence estimate of 64.8% (95% confidence interval, 49.8%-76.1%) in low income countries and 47.8% (95% confidence interval, 44.7%-50.8%) in lower-middle income countries. The most frequent serotypes were 6A, 6B, 19A, 19F, and 23F.
CONCLUSIONS
In low and lower-middle income countries, pneumococcal carriage is frequent, especially in children, and the spectrum of serotypes is wide. However, because data are limited, additional studies are needed to adequately assess the impact of PCV introduction on carriage of respiratory bacteria in these countries.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carrier State; Child; Child, Preschool; Developing Countries; Humans; Income; Infant; Infant, Newborn; Middle Aged; Pneumococcal Infections; Pneumococcal Vaccines; Prevalence; Respiratory Tract Infections; Risk Factors; Serogroup; Streptococcus pneumoniae; Vaccination; Young Adult
PubMed: 25084351
DOI: 10.1371/journal.pone.0103293