The edition · Paediatrics
Oral amoxicillin holds against injectables in chest-indrawing pneumonia, and probiotics made juvenile arthritis no better
Three trials and 4,864 children: outpatient oral amoxicillin matched inpatient injectable antibiotics on treatment failure for chest-indrawing pneumonia without danger signs, with lower mortality. The absolute numbers are small; the programmatic implication is not.
The edition in brief
Four findings and a pearl for the paediatric desk. A Cochrane review of eight randomised trials in 2,528 children and adolescents found iodine supplementation produces a slight improvement in cognitive function (standardised mean difference 0.19, 95% CI 0.04 to 0.34, high certainty from a single 166-child study), likely reduces hypothyroidism substantially and likely reduces infant mortality (risk ratio 0.32, 0.14 to 0.73), with little effect on growth and very uncertain evidence on goitre. The trials are old - 1982 to 2009 - and mostly used single large doses. A meta-analysis restricted to paediatric randomised trials found ibuprofen no better than paracetamol for acute mild-to-moderate pain: pooled standardised mean difference of -0.28 (95% CI -0.57 to 0.00, p=0.052) from three trials with 196 analysable children, and no difference in pain freedom, with certainty graded low. The PERMAJI trial randomised 44 children with juvenile idiopathic arthritis to VSL#3 probiotic or placebo for three months; ACR Pedi 30 response was 47% versus 63% (p=0.33), and under worst-case handling of missing data 36% versus 68% (p=0.03), while faecal TLR4 agonist activity rose - a signal pointing the wrong way. The practice-changer is a WHO-relevant meta-analysis: in children aged 2 to 59 months, oral amoxicillin cut treatment failure by 16% against no antibiotic for fast-breathing pneumonia, and for chest-indrawing pneumonia without danger signs matched injectable antibiotics on failure while mortality was 72% lower. Plus a pearl on counting respiratory rate properly.
Iodine supplementation: a small cognitive gain, fewer hypothyroid children, and trials that stopped in 2009
Where salt iodisation is patchy, iodine status is worth establishing at population level - but nothing here supports prescribing iodine to an individual child in clinic.
Ibuprofen is not better than paracetamol for acute pain in children
Pick between ibuprofen and paracetamol on contraindications and the nature of the pain - the efficacy difference in children does not reach significance.
Probiotics in juvenile idiopathic arthritis: no clinical benefit, and a signal pointing the wrong way
Tell families that a randomised trial of VSL#3 in juvenile idiopathic arthritis showed no clinical benefit, with response rates numerically lower than placebo.
Count the respiratory rate for a full minute, on a settled child
Count for sixty seconds on a settled child, record the number and the temperature, and check the danger signs before the rate decides the plan.
Oral amoxicillin matched injectable antibiotics for chest-indrawing pneumonia without danger signs
A child aged 2 to 59 months with chest indrawing and no danger signs can be treated at home with oral amoxicillin rather than admitted for injectables - provided the danger signs are properly assessed and follow-up is arranged.
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