PROTOCOL FOR SYSTEMATIC REVIEW AND META-ANALYSIS OF ANTIBIOTICS FOR COMMUNITY ACQUIRED PNEUMONIA IN CHILDREN

Temesgen Negassa*, Dinka Dugassa, Dereilo Bekere, Beltibo Busha Gamachu, Firomsa Bekele, Chaltu Hinkosa

ABSTRACT

Background: Pneumonia is the leading cause of mortality in children under five, particularly in low- and middle-income countries where bacterial pathogens are common. Early empirical antibiotic therapy is critical to improving clinical outcomes. Despite its public health importance, there is currently no comprehensive systematic review comparing the effectiveness of different antibiotic regimens for community-acquired pneumonia (CAP) in children. Objectives: To identify and compare the effectiveness of various antibiotic therapies used to treat CAP in children less than 18 years of age, based on data from randomized controlled trials (RCTs). Methods and Analysis: This systematic review and meta-analysis protocol follows the PRISMA-P guidelines and will be registered with PROSPERO. A comprehensive literature search will be conducted in CENTRAL, MEDLINE, EMBASE, Ovid, CINAHL, and Web of Science for RCTs published between 1 July 2013 and 30 December 2023. Eligible studies will involve pediatric patients with WHO-defined or radiologically confirmed CAP and compare two or more antibiotic regimens in either hospital or outpatient settings. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Jadad scale. The primary outcome is clinical cure; secondary outcomes include treatment failure, relapse, and hospitalization rate, length of stay, complications, and mortality. Treatment success rates (TSRs) will be pooled using a DerSimonian and Laird random-effects model via Metaprop in Stata. Heterogeneity will be evaluated with Cochran’s Q and I⊃2; statistics, and publication bias assessed with funnel plots and Egger’s test. Cumulative and sensitivity analyses will be conducted to assess robustness and time trends. Selection Criteria: Randomized controlled trials comparing two or more antibiotics in children (Ethics and Dissemination: No ethical approval is required, as this study will analyze data from previously published research. The findings will be disseminated through publication in a peer-reviewed journal and presentation at scientific conferences. Conclusions: This review will provide evidence-based recommendations on the most effective antibiotic treatments for pediatric CAP and guide clinical decision-making in both hospital and community settings.

Keywords:

Community-acquired pneumonia, children, antibiotic therapy, randomized controlled trials, systematic review, meta-analysis, empirical treatment.

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