A child with severe pneumonia can be treated with oral antibiotics as safely and effective at home as in hospital, says an article in The Lancet, this week's issue.
Approximately four children under five years of age die as a result of pneumonia every minute - 2 million per year worldwide.
WHO guidelines recommend that children with non-severe pneumonia (acute lower respiratory tract infections with fast breathing) be treated at home, while children with severe pneumonia and very severe pneumonia be hospitalized and treated with such parenteral antibiotics as benzylpenicilllin or ampicillin.
Getting children with severe pneumonia into a hospital is often not possible in several parts of the world. In areas where transportation is inadequate, the cost of transportation is prohibitive, distances are huge, and there is a lack of childcare at home, sick children often do not get to hospital. In practice, the current guidelines for such children are ineffective. The authors stress that community-based treatment options would significantly boost the number of children who would receive treatment, many deaths would be prevented, money would be saved, and there would be a reduction in the potential hazards of in-hospital treatment.
Dr Donald Thea, Boston University School of Public Health, Boston, USA, and team looked at 2,037 children aged from 3 months to just under six years at seven sites in Pakistan. They wanted to find out whether the treatment for severe pneumonia at home with oral antibiotics was as safe and effective as parenteral treatment in hospital. Half the children were randomly selected to receive oral amoxicillin syrup and sent back home, while the other half were hospitalized and received intravenous ampicillin for forty-eight hours.
By the sixth day there were 77 treatment failures among the children who stayed at home, compared to 87 among the hospitalized children - a percentage treatment failure rate of 7.5% and 8.6% respectively. Within 14 days of enrolment 5 children died, four of them from the hospitalized group. In each case, treatment failure was declared before death and the antibiotic was changed. No serious adverse events were reported in the trial, and none of the deaths were thought to be linked to study treatment, the researchers wrote.
"Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalization and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised," the researchers say.
The Lancet 2008; 371:49-56 DOI:10.1016/S0140-6736(08)60071-9
Approximately four children under five years of age die as a result of pneumonia every minute - 2 million per year worldwide.
WHO guidelines recommend that children with non-severe pneumonia (acute lower respiratory tract infections with fast breathing) be treated at home, while children with severe pneumonia and very severe pneumonia be hospitalized and treated with such parenteral antibiotics as benzylpenicilllin or ampicillin.
Getting children with severe pneumonia into a hospital is often not possible in several parts of the world. In areas where transportation is inadequate, the cost of transportation is prohibitive, distances are huge, and there is a lack of childcare at home, sick children often do not get to hospital. In practice, the current guidelines for such children are ineffective. The authors stress that community-based treatment options would significantly boost the number of children who would receive treatment, many deaths would be prevented, money would be saved, and there would be a reduction in the potential hazards of in-hospital treatment.
Dr Donald Thea, Boston University School of Public Health, Boston, USA, and team looked at 2,037 children aged from 3 months to just under six years at seven sites in Pakistan. They wanted to find out whether the treatment for severe pneumonia at home with oral antibiotics was as safe and effective as parenteral treatment in hospital. Half the children were randomly selected to receive oral amoxicillin syrup and sent back home, while the other half were hospitalized and received intravenous ampicillin for forty-eight hours.
By the sixth day there were 77 treatment failures among the children who stayed at home, compared to 87 among the hospitalized children - a percentage treatment failure rate of 7.5% and 8.6% respectively. Within 14 days of enrolment 5 children died, four of them from the hospitalized group. In each case, treatment failure was declared before death and the antibiotic was changed. No serious adverse events were reported in the trial, and none of the deaths were thought to be linked to study treatment, the researchers wrote.
"Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalization and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised," the researchers say.
The Lancet 2008; 371:49-56 DOI:10.1016/S0140-6736(08)60071-9
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