Table 5.
Pneumococcal vaccination studies examining antimicrobial use in children: RCTs and non-randomized cohort studies.
| Reference (SIGN) | Design | Population | N | Mean age (range)* | Vaccine | Outcome description | Outcome |
Direction effect (−, −/+, +) | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Measure | Outcome | 95% CI/p-value | ||||||||
| Palmu (++) [19] | RCT | Infants/children | 30,527 | NR | PHiD-CV10 | Antimicrobial treatment | VE | 7% | 0%−14% | + |
| Dagan (++) [18] | RCT | Children | 131/130 | 28 mo | PCV9 | Antimicrobial days for URI | RR | 0.90 | 0.84–0.97/.005 | + |
| Antimicrobial days for LRI problems | RR | 0.53 | 0.45–0.62/<.001 | + | ||||||
| Antimicrobial days for OM | RR | 0.80 | 0.74–0.86/<.001 | + | ||||||
| Antimicrobial days for Others | RR | 1.01 | 0.87–1.16/0.918 | −/+ | ||||||
| Esposito (++) [22] | Non-randomized | Infants | 811/744 | 82 days** (75–105) | PCV7 | Antimicrobial courses | RR | 0.89 | 0.83–0.94/.0001 | + |
| 6–12 mo | Antimicrobial courses | RR | 1.01 | 0.89–1.14/.87 | −/+ | |||||
| 13–18 mo | Antimicrobial courses | RR | 0.86 | 0.76–0.95/.004 | + | |||||
| 19–24 mo | Antimicrobial courses | RR | 0.89 | 0.79–1.01/.06 | −/+ | |||||
| 25–30 mo | Antimicrobial courses | RR | 0.78 | 0.67–0.90/.0008 | + | |||||
| O’Grady (+) [26] | RCT | Children | 31/30 | 6.8 yrs (NR) | PHiD-CV10 | Antimicrobial courses: <14 days post-dose 2 |
Risk difference | −1.1/100 weeks | −2.6–0.1 | −/+ |
| <28 days post-dose 2 | Risk difference | −0.7/100 weeks | −2.4–1.1 | −/+ | ||||||
| <14 days post-dose 2 | IDR | 0.81 | 0.61–1.09 | −/+ | ||||||
| <28 days post-dose 2 | IDR | 0.87 | 0.66–1.15 | −/+ | ||||||
| Fireman (+) [25] | RCT | Infants/children | 18,926/18,942 | NA | PCV7 | Antimicrobial prescriptions | Difference*** | 5.4% | 4.0%–6.7% | + |
*Vaccinated/unvaccinated; **Median; ***Reduced antimicrobial prescriptions in all follow-up starting at Dose 1; CI: confidence interval; IDR: incidence density ratio; LRI: lower respiratory infection; mo: months; NR: not reported; OM: otitis media; OR: odds ratio; PHiD-CV10: pneumococcal Haemophilus influenzae protein D conjugate vaccine; PCV7: heptavalent pneumococcal conjugate vaccine; PCV9: 9-valant pneumococcal conjugate vaccine; RCT: randomized controlled trial; RR: relative risk; SIGN: Scottish Intercollegiate Guidelines Network; URI: upper respiratory illness; VE: vaccine effectiveness.