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Oral Antibiotics Effective for Severe Pneumonia in Children

Research has implications for treatment of pneumonia in developing countries

FRIDAY, Jan. 4 (HealthDay News) -- An outpatient regimen of high-dose oral amoxicillin is equivalent to hospitalization and treatment with parenteral antibiotics in a sample of Pakistani children with severe pneumonia, findings that could impact current World Health Organization (WHO) guidelines advocating hospitalization of children with severe pneumonia, according to an article published in the Jan. 5 issue of The Lancet.

Tabish Hazir, of Pakistan Institute of Medical Sciences in Islamabad, Pakistan, and colleagues randomized 2,037 children aged 3 months to 59 months with severe pneumonia presenting to seven Pakistani health facilities to be treated with hospitalization and parenteral ampicillin for 48 hours, followed by oral amoxicillin for three days, or to receive home-based treatment consisting of five days of high-dose oral amoxicillin. The primary outcome measured was treatment failure, defined as clinical deterioration by day 6.

In an intention-to treat analysis, 8.6 percent of hospitalized patients failed treatment compared to 7.5 percent of ambulatory patients. Five children died within two weeks, one in the ambulatory group and four in the hospitalized group.

"Ambulatory management of severe pneumonia in children has the potential to improve access to care and inequity while reducing costs and mortality from pneumonia. However, care must be used in applying this recommendation to certain populations -- children aged 3-5 months, children who are significantly underweight for age and children with very fast breathing -- where rates of treatment failure are higher," the authors conclude.

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