Recommendations for treatment of childhood non-severe pneumonia

• Type of Material: Article
• Authors: Gavin B. Grant, Centers for Disease Control and Prevention; Harry Campbell, University of Edinburgh; Scott Dowell, Emory University; Stephen M. Graham, University of Malawi; Keith Klugman, Emory University; E. Kim Mulholland, London School of Hygiene & Tropical Medicine; Mark Steinhoff, Johns Hopkins University; Martin W. Weber, Indonesia Country Office; Shamim Qazi, WHO
• Language: English
• Date: 2009-03-01
• Publisher: Elsevier Science Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © World Health Organization 2009. Published by Elsevier Ltd. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/S1473-3099(09)70044-1
• Title of Journal or Parent Work: The Lancet: Infectious Disease
• Volume: 9
• Issue: 3
• Start Page: 185
• End Page: 196
• Grant/Funding Information: None declared
• Keywords: Respiratory tract infection; Case management; Trimethoprim sulfamethoxazole; Human metapneumovirus; Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Acute otitis media; Chlamydia pneumoniae; Haemophilus influenzae; Community-acquired pneumonia; Pneumococcal conjugate vaccine; Streptococcus pneumoniae
• Research Categories: Health Sciences, Hygiene; Health Sciences, Epidemiology; Health Sciences, Immunology

Abstract

WHO recommendations for early antimicrobial treatment of childhood pneumonia have been effective in reducing childhood mortality, but the last major revision was over 10 years ago. The emergence of antimicrobial resistance, new pneumonia pathogens, and new drugs have prompted WHO to assemble an international panel to review the literature on childhood pneumonia and to develop evidence-based recommendations for the empirical treatment of non-severe pneumonia among children managed by first-level health providers. Treatment should target the bacterial causes most likely to lead to severe disease, including Streptoccocus pneumoniae and Haemophilus influenzae. The best first-line agent is amoxicillin, given twice daily for 3-5 days, although co-trimoxazole may be an alternative in some settings. Treatment failure should be defined in a child who develops signs warranting immediate referral or who does not have a decrease in respiratory rate after 48-72 h of therapy. If failure occurs, and no indication for immediate referral exists, possible explanations for failure should be systematically determined, including non-adherence to therapy and alternative diagnoses. If failure of the first-line agent remains a possible explanation, suitable second-line agents include high-dose amoxicillin-clavulanic acid with or without an affordable macrolide for children over 3 years of age. © 2009 Elsevier Ltd. All rights reserved.