Background Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. Methods Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. Results Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. Conclusion As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.

Background Azithromycin (AZI) is increasingly used for childhood asthma despite limited and inconsistent data. We aimed to evaluate the efficacy and safety of AZI in childhood asthma. Methods We searched seven databases to include randomized controlled trials (RCTs) of AZI in the treatment of childhood asthma. Four reviewers independently screened the records. Risk of Bias 2 was used to assess the quality of RCTs. Risk ratios with 95% confidence interval (CI) from dichotomous outcomes, and mean difference (MD) with 95% CI from continuous outcomes were pooled. Results We included 19 eligible reports from 17 studies. The prevalence of exacerbations in AZI + budesonide (BUD) + β2 agonist (BA) group was lower than BUD + BA group (four [13%] vs. 19 [63%], p < 0.05) in 6– 14 years old children with chronic persistent asthma. AZI plus antiasthma drugs (AADs) could improve the posttreatment childhood asthma control test score (MD = 2.97; 95% CI, 2.39–3.54) compared to AADs alone in children with chronic persistent asthma. AZI plus AADs could improve posttreatment forced expiratory volume in 1 s of predicted value/forced vital capacity % (MD = 10.24%; 95% CI, 6.44%–14.03%) and posttreatment peak expiratory flow % of predicted value (MD = 7.00%; 95% CI, 2.53%–11.47%) compared to AADs alone in children with chronic persistent asthma. The most common adverse reactions of AZI combined with other drugs were gastrointestinal reactions. Conclusions AZI may be beneficial in improving some clinical symptoms and lung functions in older asthma children (over 6 years old) with persistent asthma. But it still requires further research.

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Background: Evidence suggests controversial results based on the antibacterial and anti-inflammatory effects of azithromycin (AZI) in the treatment of childhood asthma. This study was to further evaluate the efficacy and safety of AZI in childhood asthma. Methods: We searched PubMed, Embase (via Ovid), Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals database, WANFANG, and Chinese Biomedical Literature database from inception to November 11, 2020. Randomized controlled trials (RCTs) of AZI versus placebo or one positive control drug, AZI plus anti-asthma drugs (AADs) versus the same AADs, and AZI plus AADs versus placebo or one positive control drug plus the same AADs were included. Primary outcomes were number of exacerbations (NoE); score of clinical tools to assess asthma control after treatment; number of days to relieve symptoms with β2 agonist (DBA); post-treatment lung function indicators, including FEV1% of predicted value (pFEV1%), FVC% of predicted value (pFVC%), FEV1/FVC% of predicted value (pFEV1/FVC%), and PEF% of predicted value (pPEF%). Secondary outcomes were post-treatment fractional exhaled nitric oxide (FENO); post-treatment eosinophil counts in sputum (sEOS) or blood (bEOS); author self-reported outcomes related to asthma (AROs); and adverse events (AEs). Results: 61 eligible reports from 59 studies were finally included. AZI plus AADs shows no statistically significant difference in NoE (RR = 0.49; 95% CI, 0.07 – 3.26; P = 0.05) and sEOS (MD = -1.13%; 95% CI, -3.54% – 1.29%; P = 0.36) compared to AADs alone. The post-treatment C-ACT score was improved after AZI plus salmeterol and fluticasone (SF) treatment compared to SF alone (MD = 2.97; 95% CI, 2.39 – 3.54; P < 0.001). Results from three studies which could not be meta-analyzed showed that AZI may reduce DBA compared to placebo. AZI combined with AADs could improve post-treatment pFEV1% (AZI + glucocorticoid (GC) vs GC: MD = 6.92%; 95% CI, 1.47% – 12.37%; P = 0.01. AZI + leukotriene receptor antagonist (LTRA) vs LTRA: MD = 24.88%; 95% CI, 21.47% – 28.29%; P < 0.001. AZI + GC + BA vs GC + BA: MD = 12.40%; 95% CI, 9.72% – 15.08%; P < 0.001), pFEV1/FVC% (AZI + GC vs GC: MD = 10.24%; 95% CI, 6.44% – 14.03%; P < 0.001. AZI + GC + BA vs GC + BA: MD = 9.05%; 95% CI, 5.66% – 12.44%; P < 0.001. AZI + BA vs LTRA + BA: MD = 14.48%; 95% CI, 11.84% – 17.12%; P < 0.001), and pPEF% (MD = 7.00%, 95% CI, 2.53% – 11.47%; P = 0.002), but not improve pFVC% (MD = -10.37; 95% CI, -20.86% – 0.12%; P = 0.05), compared to AADs alone. Post-treatment bEOS was significantly higher in the AZI group than in the traditional Chinese medicine compound granules group (MD = 0.07×109/L; 95% CI, 0.05×109 – 0.09×109; P < 0.001). No statistically significant difference in bEOS after treatment with AZI plus montelukast (MON) and loratadine (LOR) compared to MON and LOR (MD = 0.03×109/L; 95% CI, -0.06×109 – 0.12×109; P = 0.50). Meanwhile, AZI combined with AADs did not increase AEs (RR = 0.76; 95% CI, 0.51 – 1.13; P = 0.17). Conclusions: AZI was beneficial in improving some clinical symptoms and lung functions in childhood asthma. AZI did not increase AEs when combined with AADs.

Purpose. To systematically evaluate the safety and effectiveness of different dosages of recombinant human interferon α1b (IFNα1b) inhaled for bronchiolitis in children. Methods. 7 databases, including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang Database, and VIP, were searched. The search time was from their inception dates to March 28, 2022. A randomized controlled trial (RCT) of 2 μg/kg IFNα1b (low dosage group) monotherapy or in combination with other drugs vs. 4 μg/kg IFNα1b (high dosage group) monotherapy or in combination with the other drugs was included. The risk of bias 2.0 evaluated the RCT’s quality, and the grading of recommendations assessment, development and evaluation (GRADE) tool was used for evaluating the overall quality of the evidence. Then, a meta-analysis was performed by RevMan 5.4. Results. A total of 13 RCTs with 1719 children were included. The meta-analysis results showed that the high dosage group was significantly shorter than the low dosage group of the duration of hospital stays (MD = −0.40, 95%CI (−0.73, −0.07), P  = 0.02) (low quality), three depressions sign disappearing time (MD = −0.60, 95%CI (−1.05, −0.14), P  = 0.010) (low quality), and wheeze disappearing time (MD = −0.62, 95%CI (−1.17, −0.06),  = 0.03) (low quality). There was no significant difference between the two groups in coughing disappearing time, pulmonary rales disappearing time, wheezing sound disappearing time, or adverse event rates. Conclusions. Compared with low dosage IFNα1b, high dosage IFNα1b reduces the duration of hospital stays, the disappearance time of the three depression signs, and the disappearance time of wheeze in the treatment of bronchiolitis in children. Limited by the low quality of the evidence, the conclusions still need to be supported by high-quality studies.