Table 4 GRADE evidence profile 1: Cotrimoxazole versus amoxicillin for non-severe pneumonia^†

Outcome 1: Treatment failure based on clinical signs. Follow-up 2 - 5 days.

Importance: Critical

2 RCTs [22, 23]

no serious limitations

no serious inconsistency

serious¹

no serious imprecision³

147/922 (15.9%)

231/1132 (20.4%)

0.83 (0.65 - 1.07)

Moderate

Outcome 2: Treatment failure based on clinical signs. Follow-up 4-6 days.

Importance: Critical

1 cluster randomised trial [24]

no serious limitations

no serious inconsistency

serious²

no serious imprecision³

137/993 (13.8%)

97/1016 (9.5%)

1.52 (0.73 - 3.17)

Moderate

Outcome 3: Mortality

Importance: Critical

No studies

-

-

-

-

-

-

-

-

Outcome 4: Cost

Importance: Important

No studies

-

-

-

-

-

-

-

-

Overall quality of evidence: Moderate quality evidence suggests no difference between standard and proposed treatments for outcomes assessed

Benefits or desired effects:

Amoxicillin may be also effective for treatment of severe pneumonia, potentially simplifying treatment by reducing severity classes to two.

Risks or undesired effects

Potential for increased bacterial resistance to amoxicillin with widespread use. Reduced options for second line treatment in case of treatment failure - a whole new class of antibiotic might have to be provided as second line treatment.

Values and preferences:

Cotrimoxazole is formulated as a commonly used tablet in adults too that can be divided for children if pediatric formulations are missing - the same is not true for amoxicillin that is often distributed as capsules if syrups are not available

Costs:

Amoxicillin is more costly than cotrimoxazole (US$ 0.12 and US$ 0.21 for cotrimoxazole and amoxicillin syrups respectively for a course appropriate for a child weighing approximately 10 kg [KEMSA* July 2009])

Feasibility

Both drugs are widely available and in use