From: Reuters
Published January 4, 2008 11:28 AM

Childhood pneumonia can be treated at home

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.

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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)

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