05 January 2008

Home Treatment for Severe Pneumonia

A new study says that severe pneumonia in children can be treated at home especially in developing countries. It even suggests that the WHO guidelines calling for hospitalization of such cases be revised.
Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalisation and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised. [LANCET, 5 Jan 2008]

By high-dose oral amoxicillin, the study's authors define it as a 5-day treatment protocol of oral amoxicillin at a dose 80–90 mg/kg daily in two doses. They say this is comparable to parenteral antibiotic therapy administered in hospitals.

If we do our math, a 45-pound child suffering from severe pneumonia without complications would roughly be getting nearly 2 grams of oral amoxicillin daily in divided doses. In their experience, this works and it saves lives. In developing countries like ours, the time it takes for parents to bring their sick child to the hospital is crucial. More often than not, they are beset with transport and financial problems.

I think we need not wait for WHO to revise its guidelines. Local government units should have enough supply of oral antibiotics in their barangay town units and be ready to give them for free to parents who might need it. If something works, it must be adapted immediately.

4 reactions:

Dr. Raul Fernandez said...

Absolutely true! I encounter that all the time, pag me indigent patient who comes to you with 5-day fever, productive cough, poor intake, with subcostal and intercostal retractions, and crackles all over. Syempre, as much as possible, i-advise mo to be confined. But these days, ang dami talaga mahirap na tao who couldn't even afford to buy Tempra drops (paracetamol) worth 70 pesos. So what do you do? You think of something, a treatment protocol of your own, that the patient can take orally at home, but at the same time will cure the patient. I'm a big fan of Amoxycillin. I believe it is still the most effective broad spectrum antibiotic thats affordable, and with minimal side effects.And I use it commonly in my clinic. It is my first line antibiotic for most infections. I give it at a dose of 50-70mkd. the recommended 80-90 mkd is too high, it will give GI upset, etc. If it happens, the patient will end up in a hospital bed din because of diarrhea, which makes you regret giving it at a very high dose. Pero TID, not bid, because I believe the therapeutic level is maintained effectively when given TID - 3x/day (remember our Pharma lecture, I'm sure Dra. Reyes will agree) and it should be given for 7 days (bitin ang 5days). Symptoms resolve after 3 days of medication, if it works at all. Completing the prescribed 7-day regimen provides adequate treatment. And coupled with a mucolytic, I can tell you it works!

Nikki said...

Hi Doc Emer! Happy New Year!

I totally agree with Dr. Fernandez. Besides the Amoxycillin and mucolytic, I just advise the parents/caregiver to give lots of fluids (water and fruit juices). I have been using that regimen in my clinic (and even during my training) for years now and I have yet to get one patient admitted due to treatment failure.

Dr. Emer said...

Coming from two superb pediatricians, I really think those WHO guidelines should be revised. Who wouldn't want a treatment plan that's low-cost and equal in effectivity with hospitalization?

Svelte Rogue said...

sana nga may lunas sa mga ganyang kondisyon. sana talaga.

yari ako pag uwi namin diyan. sickly ako kapag nasa manila ako e.