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2016 ; 11
(4
): e0153877
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The Evidence for Intravenous Theophylline Levels between 10-20mg/L in Children
Suffering an Acute Exacerbation of Asthma: A Systematic Review
#MMPMID27096742
Cooney L
; Hawcutt D
; Sinha I
PLoS One
2016[]; 11
(4
): e0153877
PMID27096742
show ga
BACKGROUND: Intravenous theophyllines are a second line treatment for children
suffering an acute exacerbation of asthma. Various guidelines and formularies
recommend aiming for serum theophylline levels between 10-20mg/l. This review
aims to assess the evidence underpinning this recommendation. METHODS: A
systematic review comparing outcomes of children who achieved serum theophylline
concentrations between 10-20mg/l with those who did not. Primary outcomes were
time until resolution of symptoms, mortality and need for mechanical ventilation.
Secondary outcomes were date until discharge criteria are met, actual discharge,
adverse effects and FEV1. DATA SOURCES: MEDLINE, CINAHL, CENTRAL and Web of
Science. Search performed in October 2015. ELIGIBILITY CRITERIA: Interventional
or observational studies utilizing intravenous theophyllines for an acute
exacerbation of asthma in children where serum theophylline levels and clinical
outcomes were measured. FINDINGS: 10 RCTs and 2 observational studies were
included. Children with serum levels between 10-20mg/l did not have a reduction
in duration of symptoms, length of hospital stay or need for mechanical
ventilation or better spirometric results compared with levels<10mg/l. Levels
above 20mg/l are not associated with higher rates of adverse effects. This study
is limited due to heterogeneity in the way theophylline levels were reported and
poor surveillance of adverse effects across studies. CONCLUSION: Dosing
strategies aiming for levels between 10-20mg/l are not associated with better
outcomes. Clinicians should rely on clinical outcomes and not serum levels when
using intravenous theophyllines in children suffering an acute exacerbation of
asthma.
|Acute Disease
[MESH]
|Administration, Intravenous
[MESH]
|Asthma/blood/*drug therapy
[MESH]
|Bronchodilator Agents/administration & dosage/*blood/*therapeutic use
[MESH]
|Child
[MESH]
|Humans
[MESH]
|Practice Guidelines as Topic
[MESH]
|Theophylline/administration & dosage/*blood/*therapeutic use
[MESH]