Experts say children with severe pneumonia are better off being treated at home

Jan 6 2008

The World Health Organisation (WHO) says children with severe pneumonia are better off being treated at home instead of sending them to hospital.

The WHO believes such an approach could save many lives in poor nations.

Using research from a Boston University School of Public Health study to support the claim, the WHO says antibiotic pills given at home were as effective as injectable antibiotics against pneumonia.

Pneumonia is the biggest killer of children under five years old and the WHO says every minute, four children die from the lung inflammation, which can range in seriousness from mild to life-threatening; pneumonia contracted in hospital can be particularly virulent.

It seems that while most cases of pneumonia in the developed world are from a viral infection, in developing nations about 60 percent of cases are caused by bacteria that can be treated with antibiotics and it is these are the children who are most affected.

Current WHO guidelines advise that children with mild pneumonia are given oral antibiotics while more severe cases are referred to hospitals for treatment with antibiotics by injection.

However in poor countries access to hospitals is often not easy for families which results in the death of many children before they reach hospital or else they are too sick to be treated once they arrive there.

According to the WHO children with severe pneumonia are vulnerable to infections as a result of weak immunity and could be at increased risk in crowded hospital wards.

The WHO plans to revise its guidance in light of the new research which involved 2,037 children in Pakistan, aged between 3 and 59 months who had severe pneumonia.

Around half of the children were treated in hospital, receiving the standard antibiotic ampicillin through an intravenous drip, while the other half were treated at home, receiving amoxicillin in an oral syrup.

Within 14 days of the start of treatment, one of them in the home-based group and four in the hospitalised group died.

The researchers say none of the deaths could be associated with the treatment given to them and none of the other children in the trial had any serious adverse effects from the drugs.

The researchers found that a treatment failure rate of 7.5 percent among children given drugs at home, compared to 8.6 percent among those in hospital.

The study however also found that for some children with very severe pneumonia they would still require injectible antibiotics in hospital.

Shamim Qazi, a medical officer with the WHO's department of child and adolescent health and development, who co-authored the study says being able to treat children with severe pneumonia safely and effectively in their own homes would be of huge benefit to both families and health systems, by reducing the need for admission to hospital.

The WHO says the oral antibiotic typically used to fight pneumonia is amoxicillin, a penicillin-based formulation also used for ear, bladder and other infections.

Pneumonia leads to the death of more than two million children each year, according to figures issued in 2006 by the UN's Children's Fund (UNICEF).

The study is published in the current issue of the Lancet.