'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.
Read the full abstract
'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 strategy
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.
