Abstract

Background

'Neurodisability' refers to a group of conditions that result primarily from a neurological problem (e.g. cerebral palsy), neuromuscular problem (e.g. a muscular dystrophy) or developmental problems (e.g. developmental impairment, Down syndrome). Children and young people with these conditions may have similar problems with mobility, feeding and airway clearance. Chest and breathing problems (including pulmonary infections) are commonly experienced by children and young people with neurodisabilities and are often a cause for them requiring hospital care.

For those who are unable to completely clear their airway of secretions, or have frequent infections, pulmonary infections may not be able to be completely eradicated and therefore become chronic. It is unclear what treatment is best for children and young people in this position.

Objectives

To assess the effectiveness and adverse effects of antibiotic treatment for chronic pulmonary infection in children and young people living with a neurodisability, including quality‐of‐life measures, effects on hospitalisation and healthcare contacts.

Search methods

We searched the Cochrane Airways Trials Register, Cochrane Acute Respiratory Infections Group Register of Trials (CARIGRT), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), OpenGrey (www.opengrey.eu) and three trials registries up to 8 February 2022. Additionally, we identified related systematic reviews through Epistemonikos.org (8 February 2022) and searched reference lists of these.

Selection criteria

All randomised controlled trials of antibiotic therapy for chronic pulmonary infection in children and young people up to the age of 18 living with a neurodisability were eligible.

Data collection and analysis

Two independent review authors screened results of the searches against predetermined inclusion criteria, resolving any discrepancies by discussion.

Main results

We identified a total of 1968 independent records through our searches, of which we assessed six full‐text articles for eligibility. We identified one ongoing study as well as one related substudy but did not identify any completed studies eligible for inclusion in this systematic review.

Authors' conclusions

The findings of this systematic review highlight a lack of evidence in the antibiotic treatment of chronic pulmonary infection in children and young people up to the age of 18 living with a neurodisability. Further research examining this topic is therefore required.

Author(s)

Juliane RF Sanner, Kamini Jain, Jane Williams, Matthew N Hurley

Abstract

Plain language summary

Antibiotics for children with a neurodisability and long‐term lung infection

'Neurodisability' refers to a group of conditions that result primarily from a neurological problem (e.g. cerebral palsy), neuromuscular problem (e.g. a muscular dystrophy) or developmental problems (e.g. developmental impairment, Down syndrome). Children and young people with these conditions may have similar problems with mobility, feeding and coughing. Chest and breathing problems (including lung infections) are commonly experienced by children and young people with neurodisabilities and are often a cause for them needing hospital care.

For those who are unable to completely clear their chests of secretions, or have frequent infections, lung infections may not be able to be completely cleared ‐ they become 'chronic infections'. It is unclear what treatment is best for children and young people in this position.

We sought to systematically review all the clinical trials looking at the antibiotic treatment of lung infection for children and young people with chronic lung infection. We reviewed a total of 1968 published studies up to February 2022, from a number of different online databases, but none were relevant to be included in this review. Two studies were ongoing and as such could not be included in this current version.

We are disappointed that we did not find any clinical trials to answer this important question. This is a key focus for future work so that children and young people in this position can receive the best possible treatment.

Author(s)

Juliane RF Sanner, Kamini Jain, Jane Williams, Matthew N Hurley

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

Clinically, this systematic review is unable to contribute to the understanding of the effect of antibiotics in chronic pulmonary infection in children with a neurodisability due to a lack of evidence. It is important to highlight that this current absence of evidence is not equivalent to evidence of absence of effect. Therefore, until further evidence becomes available, clinicians may want to continue to use antibiotics empirically and based on clinical experience, but should be aware that there is currently no available randomised controlled trial (RCT)‐based evidence to best guide the use, selection or administration route of antibiotics in chronic pulmonary infection in children and young people living with a neurodisability. Potential adverse effects of antibiotic usage on an individual level as well as risks on a population level will continue to need to be considered clinically.

Implications for research 

Antibiotic treatment for chronic pulmonary infection in children and young people living with a neurodisability is an important topic due not only to the associated morbidity and mortality related to pulmonary infection in this group, but also due to wider societal issues around impact on families and rising antimicrobial resistance. High‐quality, multicentre RCTs are therefore urgently needed to determine the utility and necessity of antibiotics in this setting.

When designing RCTs, provision of antibiotics as an intervention will need to be assessed in a multi‐faceted approach involving careful consideration of medication class, administration method, dosage and duration of treatment. A holistic approach should be used, and outcomes to assess the impact on the child’s health should include not only measures of healthcare utilisation, but importantly also patient‐reported outcome measures (PROMs), quality of life measures and an assessment of the impact on families/carers.

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