Atkinson 2007.
| Methods | Multicentre randomised controlled trial | |
| Participants | Children admitted with pneumonia in 8 hospitals. At least 3 inclusion criteria for diagnosis of pneumonia. Respiratory symptoms or signs, fever > 37.5 °C, radiographically confirmed pneumonia (defined as confluent area of consolidation agreed subsequently by 2 independent radiologists) | |
| Interventions | Oral amoxycillin (doses for 6 months to 12 years of age 8 mg/kg/dose 3 times a day above 12 years of age 500 mg 3 times a day) or IV benzyl penicillin (doses 25 mg/kg/dose 4 times a day) | |
| Outcomes | The primary outcome measure was time from randomisation until the temperature was 38 °C for 24 continuous hours and oxygen requirement had ceased (the latter only applicable to those children who required oxygen during the admission) Secondary outcomes included time in hospital, complications (empyema, re‐admission, further courses of antibiotics), duration of oxygen requirement and time to resolution of illness |
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| Notes | Exclusion criteria were wheeze, oxygen saturations, 85% in air, shock requiring 20 ml/kg fluid resuscitation, immunodeficiency, pleural effusion at presentation requiring drainage, chronic lung condition (excluding asthma), penicillin allergy and age 6 months Treatment with oral antibiotics in the 5 days prior to admission, including amoxycillin, was not an exclusion criterion |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Block randomisation list generated |
| Allocation concealment (selection bias) | Low risk | A block randomisation sequence stratified by centre was produced using a random number generator. The sequence was accessed via the Internet, therefore allowing concealment of allocation |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Open‐label study |
| Selective reporting (reporting bias) | Unclear risk | While the authors mention the primary outcome as "the time from randomisation until the temperature was less than 38 degree celsius for 24 continuous hours and oxygen requirement had ceased", they calculated the sample size based on the proportion meeting the primary outcome measure at any time. The authors have not reported on these proportions in the results |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | None |
| Other bias | Low risk | Funded by the British Lung Foundation |