Junayyah A. Sarip: 1 Year Pediatric Resident

JOURNAL
APPRAIS
AL
Junayyah A. Sarip
1st year Pediatric Resident
OBJECTIVES
● To appraise an article on therapeutics using EBM protocol
● To give conclusion based on EBM protocol and apply these in the
clinical setting
CASE
SCENA
RIO
Identifying information
P.H.
3 year old
Filipino
Islam
Marawi City
Chief
complaint
cough
History of Present Illness
3 days PTC, patient had onset of occasional nonproductive cough

associated with colds and intermittent fever. No consultation done.
No medications taken.
1 days PTC, now with productive cough. Due to persistence of

productive cough prompted consult at OPD.
Past Medical History
(-) previous hospitalization
(-) childhood illness
(-) history of trauma, surgery, fall
(-) allergy to food and medications
Personal and Social History
• Patient lives with parents and siblings
• 3rd in rank
• No pets in the house
• Father is a smoker
• Drinking supply from refilling station
Physical Examination
• Awake, not in respiratory distress

• 80/50 mmHg, 95 bpm, 36 cpm, 37.0 C, 99% at room air
• SKIN: Brown, good skin turgor and mobility
• HEENT: Anicteric sclerae, pink palpebral conjunctiva
• C/L: Equal chest expansions, (-) retractions, crackles bilateral
• CVS: Adynamic precordium, (-) murmur
• ABDOMEN: flat, soft, nontender
• EXTREMITIES: warm ext, strong peripheral pulses, CRT <2 sec
PLAN
→ Diagnostics: None
→ Therapeutics:
Amoxicillin 70 mkday TID for 5 days
Paracetamol 10 mkdose q4 hours PRN fever
ASSESSMENT
Pediatric
Community
Acquired
Pneumonia - B
Community Acquired Pneumonia
Is one of the most common serious infections in children
Pneumonia remains to be one of the leading cause of under-five

deaths globally
Inflammation of the lung parenchyma
Cough
Fever
Tachypnea
Retractions
Nasal flaring
grunting
CRITICAL
APPRAISAL
Research Question
Among Children aged 24 to

71 months with nonsevere
CAP, does short course of
antibiotics will demonstrate
CREDITS: This presentation template was created by Slidesgo, including
early clinical response?

icons by Flaticon and infographics & images by Freepik
RELEVANCE
Is the objective of the journal
comparing therapeutic
interventions similar to your
clinical dilemma?
YES
RELEVANCE
P Child with nonsevere pneumonia
I Short course antibiotics
C Long course antibiotics
O Early clincal response
M Randomized Controlled Trial

VALIDITY
Were patients randomly

assigned to treatment groups?
YES
VALIDITY
Were patients in the study
groups similar with respect to
known factors?
Inclusion Exclusion
Child age 6 to 71 months Subjective fever or documented

temperature 38.3 C or higher
Diagnosed with uncomplicated CAP Tachypnea
Site of initial diagnosis Severe cough
Initial antibiotic treatment

VALIDITY
Was the study blinded?
YES
VALIDITY
Was the follow up complete?
YES
VALIDITY
Were the patients analyzed in
the groups to which they were
randomized?
YES
VALIDITY
DROP OUT RATES
Treatment: short course strategy
Control: Standard course strategy
Treatment group:
19/189 = 10%
VALIDITY
DROP OUT RATES
Control group:
17/191 = 8%
VALIDITY
DROP OUT RATES
Treatment group:
19/189 = 10% 18%

Control group:
17/191 = 8%
VALIDITY
QUESTIONS RESULT
Was the assignment to the different treatment groups randomized? YES
Were patients in the study groups similar with respect to known factors? YES
Was the follow up complete? YES
Were the patients analyzed in the groups to which they were YES
randomized?
Was the study blinded? YES
RESULTS
Risk in treatment group (Rt)
13/185 = 0.07
Risk in Control group (Rc)
15/187 = 0.08
RESULTS
Risk Ratio
Rt/Rc = 0.87
RESULTS
Relative Risk Ratio

(1-RR) x 100%
(1-0.87) x 100%
= 0.13 x 100%
= 13%
RESULTS
How precise was the estimate of treatment

effect?
Confidence Interval of 95%
P value 0.02
APPLICABILITY
Can the results help me in
caring for my patients?
YES
• Patient population is similar
• Medications used in the study were similar
to those present in the local setting
• Improvement of symptoms noted.
APPLICABILITY
Will the patient, be willing to
accept and pay for the treatment in
question?
YES
• Absolute Risk Reduction (ARR) = Rc - Rt
0.08 - 0.07 = 0.01
• 2. Number needed to treat (NNT) = 1/ARR
1 / 0.01 = 100
• 3. Cost effectiveness = NNT x Cost x Duration of Treatment
100 x P 471 x 1 days = P 471
CONCLUSION
A 5 day course of guideline-
recommended antibiotics is safe
and effective approach for treating
young children with
uncomplicated outpatient CAP
who demonstrate early clinical
improvement.

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JOURNAL

3 days PTC, patient had onset of occasional nonproductive cough

1 days PTC, now with productive cough. Due to persistence of

• Awake, not in respiratory distress

Pneumonia remains to be one of the leading cause of under-five

Among Children aged 24 to

early clinical response?

P Child with nonsevere pneumonia

I Short course antibiotics

C Long course antibiotics

O Early clincal response

M Randomized Controlled Trial

Were patients randomly

Child age 6 to 71 months Subjective fever or documented

Site of initial diagnosis Severe cough

Initial antibiotic treatment

19/189 = 10% 18%

Risk in treatment group (Rt)

Relative Risk Ratio

How precise was the estimate of treatment

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