Research Article

Chinese Medicinal Herbs for Childhood Pneumonia: A Systematic Review of Effectiveness and Safety

Table 2

Characteristics of the included studies.

Wang et al., 2009 [15]

Randomized controlled trial (RCT): randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 3 weeks
Parallel/crossover/factorial RCT: parallel
Randomization method: we interviewed the author by telephone and learned that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that single blinding was used
ITT: not mentioned
Setting: inpatients
ParticipantsCountry: China
Number: 106 patients with childhood pneumonia
54 boys (50.8%) and 52 girls (49.2%); age 3–14 years old; disease duration: not mentioned
InterventionsTreatment group: modified Ma Xing Shi Gan Tang formula plus basic therapy: Mahuang 6 g, Xingren 8 g, Shigao 15 g, Gancao 5 g, Yuxingcao 20 g, lianqiao 15 g, Chanyi 10 g, and Niupangzi 15 g boiled in 3 L water and decocted to 300 mL. Orally twice daily (bid) for 3 weeks
Control group: basic therapy including intravenous infusion of azithromycin and azithromycin orally
Outcomes(1) Total effective rate
(2) Adverse effects (e.g., nausea, diarrhea, and vomit)
Notes(1) Duration of disease: not mentioned; (2) mortality: not mentioned; (3) relapse rate: not mentioned; (4) length of hospital stay: not mentioned; (5) clinical recovery (e.g., cough, fever, rales, and chest films): not mentioned; (6) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (7) economic index: not mentioned; (8) withdrawal rates: not specified; (9) source of funding: none

Zhao and Ji, 2009 [16]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup was not mentioned
MethodsStudy duration: not mentioned
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that single blinding was used
ITT: not mentioned
Setting: inpatients and outpatients
Country: China
ParticipantsNumber: 60 patients with childhood pneumonia
Treatment group: 30 patients with childhood pneumonia: 16 boys (53%) and 14 girls (47%); age: 2 months–9 years (mean: 3.5 years); disease duration: 4.00 ± 1.55 years
Control group: 30 patients with childhood pneumonia: 17 boys (56.6%) and 13 girls (43.4%); age: month –11 years (mean: 3.25 years); disease duration: 4.00 ± 1.75 years
InterventionsTreatment group: modified Ma Xing Shi Gan Tang formula plus basic therapy: Mahuang 6 g, Xingren 10 g, Shigao 20 g, Gancao 3 g, Yuxingcao 10 g, and Huangqin 10 g boiled in 3 L water and decocted to 300 mL. Orally twice daily (bid) for 3 weeks
Control group: basic therapy including intravenous infusion of azithromycin and azithromycin orally
Outcomes(1) Total effective rate
(2) Clinical recovery (e.g., cough, fever, and rales)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) clinical recovery (e.g., chest films): not mentioned; (6) economic index: not mentioned; (7) withdrawal rates: not mentioned; (8) source of funding: none;(9)adverse effects (e.g., nausea, diarrhea, and vomiting): not mentioned

Guo, 1999 [17]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsNot mentioned
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that single-blinding was used
ITT: not mentioned
Setting: not mentioned
Country: China
ParticipantsNumber: 170 patients with childhood pneumonia
Treatment group: 86 patients with childhood pneumonia: 45 boys (52.3%) and 41 girls (48.7%); age: 2 months–12 years (mean: 3.8 years)
Control group: 84 patients with childhood pneumonia: 44 boys (52.4%) and 40 girls (48.6%); age: 2 months–14 years (mean: 3.2 years)
InterventionsTreatment group: modified Ma Xing Shi Gan Tang formula plus basic therapy. Mahuang 1.5 g, Xingren 3 g, Shigao 10 g, Gancao 1.5 g, Yuxingcao 9 g, and lianqiao 3 g, boiled in 3 L water and decocted to 300 mL. Taken orally, three times daily (tid)
Control group: basic therapy included penicillin, Xianfeng Meisu, and ribavirin. Intravenous infusion of azithromycin and azithromycin orally
Outcomes(1) Total effective rate
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not specified; (7) source of funding: None; (8) time to measure outcomes: not mentioned; (9) 2. clinical recovery (e.g., cough, fever, rales, and chest films): not mentioned

Zhang, 2012 [18]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 20 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. Telephone interview with author revealed that blinding was not used
ITT: not mentioned
Setting: not mentioned
Country: China
ParticipantsNumber: 200 patients with childhood pneumonia
Treatment group: 100 patients with childhood pneumonia: 74 boys (74%) and 26 girls (47%); mean age: 6.28 years; disease duration: not mentioned
Control group: 100 patients with childhood pneumonia: 68 boys (68%) and 32 girls (32%); age and duration of disease not mentioned
InterventionsTreatment group: modified Ma Xing Shi Gan Tang formula plus basic therapy. Mahuang 3 g, Xingren 4 g, Shigao 18 g, Gancao 3 g, Yuxingcao 9 g, and Huangqin 3 g boiled in 3 L water and decocted to 300 mL, taken orally twice daily (bid)
Control group: basic therapy included intravenous infusion of azithromycin and azithromycin orally
Outcomes(1) Total effective rate
(2) Clinical recovery (e.g., cough, fever, rales, and chest films)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as the tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: none; (8) time to measure outcomes: not mentioned; (9) adverse effects: not mentioned

He, 2011 [19]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 5–7 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was not used
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 100 patients with childhood pneumonia
Treatment group: 50 patients with childhood pneumonia: 29 boys (54%) and 21 girls (42%); age: 9.6 months–12 years; disease duration: 4–8.5 days
Control group: 50 patients with childhood pneumonia: 27 boys (54%) and 23 girls (46%); age: 10.8 months–13 years; disease duration: 5–8 days
InterventionsTreatment group: modified Ma Xing Shi Gan Tang formula plus basic therapy: Mahuang 3 g, Xingren 6 g, Jinhua 6 g, Yinhua 6 g, Shigao 12 g, Yuxingcao 9 g, Banxia 6 g, and Zhigancao 3 g boiled in 2 L water and decocted to 300 mL; taken orally twice daily (bid)
Control group: intravenous infusion of azithromycin (10 mg/k · d)
Outcomes(1) Total effective rate
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not specified; (7) source of funding: none; (8) time to measure outcomes: not mentioned; (9) adverse effects: not mentioned; (10) clinical recovery (e.g., cough, fever, rales, and chest films): not mentioned

He et al., 2011[20]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 7 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was used on outcome assessment
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 80 patients with childhood pneumonia
Treatment group: 40 patients with childhood pneumonia: 22 boys (55%) and 18 girls (45%); mean age: 1.8 ± 1.10 years
Control group: 40 patients with childhood pneumonia: 21 boys (52.5%) and 19 girls (47.5%); mean age: 1.75 ± 1.151 years
Disease duration: 7.50 ± 0.50 days
InterventionsTreatment group: modified Ma Xing Shi Gan Tang formula plus basic therapy: Mahuang 3 g, Xingren 3 g, Shigao 9 g, Suzi 3 g, Shangbaipi 6 g, Kuandonghua 6 g, Banxia 6 g, Tinglizi 3 g, Yuxingcao 3 g, and Gancao 3 g boiled in 2 L water and decocted to 300 mL, taken orally twice daily (bid)
Control group: basic therapy included supporting treatment and intravenous infusion of ceftazidime (0.1 g/kg · d)
Outcomes(1) Total effective rate
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) adverse effects: not mentioned; (6) economic index: not mentioned; (7) withdrawal rates: not mentioned; (8) source of funding: none; (9) time to measure outcomes: not mentioned; (10) clinical recovery (e.g., cough, fever, rales, and chest films): not mentioned

Zhang, 2012 [21]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 5–7 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a computer-generated random-number table was used
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was used on the outcome assessment
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 128 patients with childhood pneumonia
Treatment group: 64 patients with childhood pneumonia in the treatment group
Control group: 64 patients with childhood pneumonia in the control group
In two groups, 79 boys (55%) and 49 girls (45%); age 1–14 years old; disease duration: 5–7 days
InterventionsTreatment group: San Ao Tang formula plus basic therapy; Mahuang 3 g, Xingren 12 g, Gancao 3 g boiled in 2 L water and decocted to 250 mL. Taken orally three times daily (tid)
Control group: basic therapy included symptomatic therapy and orally azithromycin 10 mg/kg one time per day (qd)
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., cough, fever, rales, and chest films); (3) adverse effects (e.g., nausea)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: none; (8) time to measure outcomes: not mentioned

Wang et al., 2009 [22]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
Study duration: 7 days
MethodsParallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a computer-generated random-number table was used
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was used on outcome assessment
ITT: not mentioned
Setting: patient source not mentioned
Country: China
Number: 200 patients with childhood pneumonia
ParticipantsTreatment group: 100 patients with childhood pneumonia in the treatment group
Control group: 100 patients with childhood pneumonia in the control group
Did not mention the number of boys and girls
Disease duration: 5–7 days
InterventionsTreatment group: Zhi Sou San formula plus basic therapy: Jiegeng 6–9 g, Gancao 3–6 g, Ziwan 3–6 g, Chenpi 3–6 g, Xingren 3–6 g, Baiguo 3–6 g, Huangqi 3–6 g, Chaomaiya 3–6 g, Yunling 3–6 g, and Baiqian 3–6 g boiled in 2 L water. Taken orally three times daily (tid)
Control group: basic therapy included symptomatic therapy and intravenous infusion of erythrocin (30 mg/kg · d)
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., cough, fever, and rales); (3) adverse effects (e.g., nausea, vomiting, and gastrointestinal bleeding)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: none; (8) time to measure outcomes: not mentioned; (9) chest films: not mentioned

Lv et al., 2009 [23]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup was not mentioned
MethodsStudy duration: 10 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was used on the outcome assessment
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 60 patients with childhood pneumonia
Treatment group: 30 patients with childhood pneumonia: 17 boys (56.7%) and 13 girls (43.3%); age: 8 months–13 years; disease duration: 7–18 days; mean: 14 days
Control group: 30 patients with childhood pneumonia: 16 boys (53.3%) and 14 girls (46.7%); age: 7 months–12 years; disease duration: 7–18 days; mean: 13.5 days
InterventionsTreatment group: self-developed TCM prescription plus basic therapy: Mahuang 3 g, Xingren 3 g, Rengongniuhuang 3 g, Bingpian 2 g, Shengshigao 3 g, Zhusha 2 g, Chuanbeimu 2 g, Huanglian 2 g, Banxia 2 g, Dannanxing 2 g, Shangbaipi 2 g, Huangqin 2 g, and Gancao 2 g boiled in 3 L water and decocted to 300 mL. Taken orally three times daily (tid)
Control group: basic therapy included symptomatic therapy and intravenous infusion of erythrocin (20 mg/kg bid)
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., cough, fever, rales, and chest films)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: none; (8) time to measure outcomes: mentioned; (9) adverse effects: not mentioned

Lei, 2010 [24]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 7 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a computer-generated random-number table was used
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was used on the outcome assessment
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 160 patients with childhood pneumonia
Treatment group: 80 patients with childhood pneumonia: 52 boys (65%) and 28 girls (35%); age: 6 months–12 years; disease duration: 2–7 days
Control group: 80 patients with childhood pneumonia: 54 boys (67.5%) and 26 girls (32.5%); age: 5 months–13 years; disease duration: 1–6 days
InterventionsTreatment group: Tanreqing injection plus basic therapy: 30–50 mL/kg Tanreqing injection + 50–100 mL 10% GS intravenous infusion once daily (qd)
Control group: basic therapy included anti-inflammatory, symptomatic therapy. Did not provide any detailed information about the anti-inflammatory, symptomatic therapy
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., cough, fever, and rales).
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: none; (8) time to measure outcomes: mentioned; (9) chest films: not mentioned; (10) adverse effects: not mentioned

Shi, 2009 [25]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 14 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was not used on study
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 80 patients with childhood pneumonia
Treatment group: 40 patients with childhood pneumonia: 21 boys (52.5%) and 19 girls (47.5%)
Control group: 40 patients with childhood pneumonia: 24 boys (60%) and 16 girls (40%); age: 5 months–13 years, in two groups; disease duration: 1–3 days
InterventionsTreatment group: Reduning injection plus basic therapy: 0.5–1.0 mL/kg · d Reduning injection + 250 mL 5% GS intravenous infusion once daily (qd)
Control group: basic therapy included symptomatic therapy and intravenous infusion of 10 mg/kg · d azithromycin for 5 days, stop 3 days, then changed to oral 10 mg/kg · d azithromycin for 3 days
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., cough, fever, rales, and chest films)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: none; (8) time to measure outcomes: mentioned; (9) adverse effects: not mentioned

Pan, 2011 [26]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 7 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that the outcome assessment was blinding
ITT: not mentioned.
Setting: patient source not mentioned.
Country: China
ParticipantsNumber: 140 patients with childhood pneumonia
Treatment group: 70 patients with childhood pneumonia: 42 boys (60%) and 28 girls (40%); age: 1–9 years old (mean: 5.1 ± 1.6 years); disease duration: 2–7 days
Control group: 70 patients with childhood pneumonia: 36 boys (51.4%) and 34 girls (48.6%); age: 1–10 years old (mean: 5.1 ± 1.6 years); disease duration: 1–7 days
InterventionsTreatment group: Reduning injection plus basic therapy: 0.5–0.8 mL/kg Reduning injection + 100 mL 5% GS intravenous infusion once daily (qd)
Control group: intravenous infusion of 10 mg/kg · d azithromycin + 5% GS once daily (qd)
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., cough, fever, and rales)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) withdrawal rates: not mentioned; (7) source of funding: mentioned; (8) time to measure outcomes: not mentioned; (9) adverse effects: not mentioned; (10) chest films: not mentioned

Duan and Feng, 2011 [27]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup was not mentioned
MethodsStudy duration: 14 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a random number table was used to generate the random sequence
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that the outcome assessment was blinded
ITT: not mentioned
Setting: outpatients and inpatients
ParticipantsCountry: China
Number: 60 patients with childhood pneumonia
In two groups: 35 boys (58.3%) and 25 girls (41.7%); age: 1–13 years; disease duration: 2–5 days
InterventionsTreatment group: Reduning injection plus basic therapy: 10–15 mL Reduning injection + 100 mL 5% GS intravenous infusion once daily (qd)
Control group: intravenous infusion of 10 mg/kg · d azithromycin + 5% GS once daily (qd)
Outcomes(1) Total effective rate; (2) clinical recovery (e.g., fever)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) length of hospital stay: not mentioned; (4) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (5) economic index: not mentioned; (6) clinical recovery (e.g., cough, rales, and chest films): not mentioned; (7) withdrawal rates: not mentioned; (8) source of funding: none; (9) time to measure outcomes: not mentioned; (10) adverse effects: not mentioned

Wei and Feng, 2003 [28]

RCT: randomization mentioned, but not described in detail
Allocation concealment: not mentioned
Followup: not mentioned
MethodsStudy duration: 7–10 days
Parallel/crossover/factorial RCT: parallel
Randomization method: a telephone interview with the author revealed that a computer-generated random-number table was used
Blinding: no detailed information on blindness was offered. A telephone interview with the author revealed that blinding was not used
ITT: not mentioned
Setting: inpatients
Country: China
ParticipantsNumber: 180 patients with childhood
In two groups: 100 boys (55.6%) and 80 girls (44.4%); age: 2 months–5 years (mean: 2.3 years); disease duration: 1–7 days
Treatment group: 90 patients with childhood pneumonia; 52 boys (57.8%) and 38 girls (42.2%)
Control group: 90 patients with childhood pneumonia; 48 boys (53.3%) and 42 girls (46.7%)
InterventionsTreatment group: Chuanhuning injection plus basic therapy: 10 mg/kg · d + 50–100 mL 10% GS or NS intravenous infusion once daily (qd)
Control group: intravenous infusion of 100 mg/kg · d piperacillin twice daily (bid)
Outcomes(1) Total effective rate; (2) length of hospital stay; (3) clinical recovery (e.g., cough, fever, rales, and chest films)
Notes(1) Mortality: not mentioned; (2) relapse rate: not mentioned; (3) TCM outcomes, such as tongue coat and pulse condition: not mentioned; (4) economic index: not mentioned; (5) withdrawal rates: not mentioned; (6) source of funding: none; (7) time to measure outcomes: not mentioned; (8) adverse effects: not mentioned