Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study
Open Access
- 4 May 2011
- journal article
- research article
- Published by Wiley in Tropical Medicine & International Health
- Vol. 16 (8), 995-1006
- https://doi.org/10.1111/j.1365-3156.2011.02787.x
Abstract
Objective A recent randomized clinical trial demonstrated home‐based treatment of WHO‐defined severe pneumonia with oral amoxicillin was equivalent to hospital‐based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries. Methods Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3–59 months with WHO‐defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80–90 mg/kg per day) for 5 days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14. Results Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2–16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3–11.2%) across all sites, varying from 6.4% (95% CI: 3.1–9.8%) in Ghana to 13.2% (95% CI: 8.4–18.0%) in Vietnam; 2.7% (95% CI: 1.5–3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6–5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7–2.3%) and central cyanosis (1.3%; 95% CI: 0.7–2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates. Conclusions Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home‐based therapy of severe pneumonia can be applied to a wide variety of settings.Keywords
This publication has 24 references indexed in Scilit:
- Adding fever to WHO criteria for diagnosing pneumonia enhances the ability to identify pneumonia cases among wheezing childrenArchives of Disease in Childhood, 2010
- Global, regional, and national causes of child mortality in 2008: a systematic analysisThe Lancet, 2010
- The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnessesBMJ, 2010
- Surveillance for InvasiveStreptococcus pneumoniaeDisease among Hospitalized Children in Bangladesh: Antimicrobial Susceptibility and Serotype DistributionClinical Infectious Diseases, 2009
- Invasive Pneumococcal Disease among Children in Rural Bangladesh: Results from a Population‐Based SurveillanceClinical Infectious Diseases, 2009
- Does 3-Day Course of Oral Amoxycillin Benefit Children of Non-Severe Pneumonia with Wheeze: A Multicentric Randomised Controlled TrialPLOS ONE, 2008
- Haemophilus influenzae type-b and non-b-type invasive diseases in urban children (years) of Bangladesh: Implications for therapy and vaccinationJournal of Infection, 2008
- Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomised equivalency trialThe Lancet, 2008
- Case Management of Childhood Pneumonia in Developing CountriesThe Pediatric Infectious Disease Journal, 2007
- Diagnoses of Acute Lower Respiratory lhlct Infections in Children in Rawalpindi and Islamabad, PakistanClinical Infectious Diseases, 1990