Home Treatment Of Pneumonia Safe, Effective

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Pneumonia

Treating children with severe pneumonia at home is just as effectiveas treating them in hospitals, a new study has found. The study resultscould significantly change the way the illness is managed in developingcountries, saving a significant number of lives every year and takingpressure off health systems.\t\t

The research, conducted inPakistan by researchers from the Boston University School of PublicHealth and supported by WHO and the U.S. Agency for InternationalDevelopment (USAID), is published this week in The Lancetmedical journal. It involved 2037 children with severe pneumonia whowere randomly assigned to get either injectable antibiotics in ahospital or antibiotic pills at home. The trial was the first tocompare the outcomes of hospital treatment of severe pneumonia withhome-based treatment, and the results demonstrate the safety andefficacy of treating it with oral antibiotics outside of a hospitalsetting.

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Pneumonia is the largest single killer of childrenunder five around the world. Almost four children die from pneumoniaevery minute. About 60% of pneumonia cases in the developing world arecaused by bacteria and can be treated with antibiotics, whereas mostcases of pneumonia in developed countries are viral.

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In the study, there were 87 (8.6%) treatment failures in thehospitalized group, and 77 (7.5%) in the group treated at home. Of thefive children (0.2%) who died during the study, four were in thehospitalized group and one was at home.

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This study confirmed the findings of three other trials in Africa,Asia, Europe and Latin America, which showed that oral antibiotics werejust as effective as injectable antibiotics in treating hospitalizedchildren with severe pneumonia.

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Far-reaching implications

"Thepotential impact of these results is enormous," said the article'sco-author Dr Shamim Qazi, Medical Officer with the WHO's Department ofChild and Adolescent Health and Development. "Effective management ofpneumonia is critical to improving child survival. Being able to treatchildren with severe pneumonia safely and effectively in their ownhomes would be of huge benefit to both families and health systems, byreducing the need for admission to hospital. We will be updating WHOguidelines in 2008 to reflect this new evidence."\t\t

"This confirmatory research in Pakistan, when implemented intoprogrammes around the globe, will increase access to critical care indisadvantaged communities and support the potential to diagnose andtreat severe pneumonia by community health workers," said Dr AlfredBartlett, Senior Advisor for Child Survival, USAID. "These findingspromise to build upon an existing approach endorsed by WHO and UNICEF,for treatment of non-severe pneumonia, that is already contributing tothe achievement of the Millennium Development Goals."

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The current guidelines advise health workers to provide oralantibiotics for cases of non-severe pneumonia and to refer severe andvery severe cases to hospitals for treatment with antibiotics byinjection. However, many children with severe pneumonia who arecurrently referred for admission to a hospital either die before theyreach there or are so sick by the time they arrive that nothing morecan be done to save them.

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A small number of cases of very severe pneumonia (around 2-3% of allpneumonia cases) will still require treatment with injectableantibiotics in a hospital.

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Families in the poorest countries, where the majority of children areaffected by pneumonia, may not have easy access to hospitals.In-patient treatment may not be an option for parents who cannot leavetheir homes to accompany the sick child. In addition, children withsevere pneumonia are vulnerable to infections as a result of weakimmunity and could be at increased risk in crowded hospital wards. Acommunity-based approach would bring treatment to people's homes, sothat children with pneumonia can be identified and begin treatmentbefore the onset of life-threatening complications.

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