Childhood pneumonia can be treated at home, say scientists

[Snowy Owl]

Childhood pneumonia can be treated at home, say scientists


Thu Jan 3, 2008 9:12pm EST

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By Will Dunham
WASHINGTON (Reuters) - Treating severe pneumonia in children at home with oral antibiotics works just as well as treating them with intravenous drugs at a hospital as advised by the World Health Organization, scientists said on Thursday.
Pneumonia is one of the world's leading child killers, particularly in South Asia and sub-Saharan Africa.
The researchers said their findings in this study of 2,037 children ages 3 to 5 in Pakistan should prompt the U.N. health agency to change its recommendations on treating severe childhood pneumonia.
The WHO advises that children with severe pneumonia be referred to a hospital and treated with intravenous antibiotics. But many sick children in developing nations are unable to reach a hospital for such treatment, the researchers said. And oral treatment at home is much cheaper, they added.
About 2 million of the 10 million deaths annually in children under age 5 worldwide are caused by pneumonia -- an inflammation of the lungs caused by an infection.
"It exceeds malaria, it certainly exceeds HIV and it exceeds diarrheal diseases, too," Dr. Donald Thea of the Boston University School of Public Health, one of the researchers, said in a telephone interview.
The study involved children with severe pneumonia who arrived at hospitals in seven locations in Pakistan. About half were sent home to take an oral antibiotic, amoxicillin, in syrup form. The others were treated intravenously in the hospital with an equivalent antibiotic, ampicillin.
STUDY: HOME TREATMENT SAFE, EFFECTIVE
The treatment at home was just as safe and effective as the hospital treatment, the study found. Of the five children who died within 14 days of entering the study, one was treated at home, with the other four among the hospitalized.
WHO guidelines call for children with pneumonia that is not severe to be treated at home with oral antibiotics, but hospitalization and intravenous antibiotics for severe cases.
The researchers said the WHO guidelines can be ineffective in practice because many children with severe pneumonia in developing countries who are referred to hospitals for treatment never reach them because they have no means of transportation or are too far away.
The researchers envision medicine distribution to children with pneumonia by health-care workers in local communities.
Treatment with oral antibiotics also avoids the possibility of infection that can occur with administering intravenous drugs due to factors like unsterile needles, they added.
"Safe community-based treatment alternatives will substantially increase the number of children who can receive effective care" and save lives and money, the researchers wrote in the Lancet medical journal.
In an commentary accompanying the study, Dr. Shams El Arifeen of the International Centre for Diarrhoeal Disease Research in Bangladesh and Dr. Abdullah Baqui of Johns Hopkins University in Baltimore called the study "a milestone."
The findings should change the management of severe pneumonia in children in developing countries, they added, writing: "The potential impact here is enormous, particularly for the many children with severe pneumonia who are referred to hospitals but never reach them."
Thea said the findings and other data will be presented to the WHO next month, with the hope of getting new treatment recommendations in about nine months to a year.


(Editing by Stacey Joyce)



© Reuters 2008 All rights reserve

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[Niko]

Severe pneumonia in children treatable at home-WHO

Severe pneumonia in children treatable at home-WHO

Severe pneumonia in children treatable at home-WHO

Thu Jan 3, 2008 7:01pm EST
By Laura MacInnis

GENEVA, Jan 4 (Reuters) - Treating children stricken with severe pneumonia at home, instead of sending them to hospital, could save scores of lives in poor nations, the World Health Organisation (WHO) said on Friday.

Citing a Boston University School of Public Health study it helped support, the WHO said that antibiotic pills given at home were as effective as injectible antibiotics against pneumonia, the largest killer of children under five years old.

Every minute, four children die from the lung inflammation, which can range in seriousness from mild to life-threatening. Pneumonia acquired in hospital can be particularly virulent.

Most developed-world cases of pneumonia develop from a viral infection, but in developing nations, where children are most affected, about 60 percent of cases are caused by bacteria that can be treated with antibiotics.

Under current WHO guidelines, children with mild pneumonia are given oral antibiotics and more severe cases are referred to hospitals for treatment with antibiotics by injection.

But in poor countries, families often cannot easily access hospitals, and many children die before they reach hospital or are too sick to be treated once they arrive.

"In addition, children with severe pneumonia are vulnerable to infections as a result of weak immunity and could be at increased risk in crowded hospital wards," according to the United Nations health agency.

It said it would revise its guidance this year in light of the research involving 2,037 children in Pakistan, which showed a treatment failure rate of 7.5 percent among children given drugs at home, compared to 8.6 percent among those in hospital.

Some children with very severe pneumonia will still require injectible antibiotics in hospital, the study found.

"The potential impact of these results is enormous," said Shamim Qazi, a medical officer with the WHO's department of child and adolescent health and development, who co-authored the study appearing in the Lancet medical journal.

"Being able to treat children with severe pneumonia safely and effectively in their own homes would be of huge benefit to both families and health systems, by reducing the need for admission to hospital," Qazi said.

A WHO spokeswoman said the oral antibiotic typically used to fight pneumonia is amoxicillin, a penicillin-based formulation also used for ear, bladder and other infections. Amoxicillin is produced by pharmaceutical companies including GlaxoSmithKline (GSK.L: Quote, Profile, Research) and is also available as a generic medicine.

http://www.reuters.com/article/latestCrisis/idUSL0363306

 

[Sally Furniss]

Re: Childhood pneumonia can be treated at home, say scientists

Managing severe pneumonia in children in developing countries

Despite advances in our understanding of the epidemiology anddistribution of deaths from pneumonia,¹ more than 150 millioncases of pneumonia still occur annually, with almost 2.4 milliondeaths worldwide. Pneumonia is perhaps the most frequent causeof death in children under 5, including during the newborn period.²Deaths from pneumonia in children have increased in the wakeof the HIV epidemic in Africa. Most deaths occur early in thecourse of illness. Because severe pneumonia is usually relatedto bacterial infection, treatment has largely focused on variousantibiotic strategies.


In the accompanying randomised controlled trial, Asghar andcolleagues compare the effectiveness of injectable ampicillinplus gentamicin or chloramphenicol in children aged 2-59 monthswith severe pneumonia (defined by World Health Organizationcriteria).³ The trial took place in inpatient wards in tertiarycare hospitals in Bangladesh, Ecuador, India, Mexico, Pakistan,Yemen, and Zambia. Significantly more children failed treatmentwith chloramphenicol <nobr>. . .</nobr> [Full text of this article]

Zulfiqar A Bhutta, Husein Lalji Dewraj professor and chairman

¹ Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
zulfiqar.bhutta@aku.edu



http://www.bmj.com/cgi/content/extract/336/7635/57