Pneumonia in and out of the hospital

Hospitals are dangerous places, but sometimes you have to be there. If you are a child in the developing world sick with pneumonia, the World Health Organization (WHO) thinks that's one of the times. Pneumonia is the big killer of children globally, so WHO guidelines call for children with severe pneumonia to be treated with intravenous antibiotics in the hospital. Now a landmark clinical trial from a team at the Boston University School of Public Health and published this week in The Lancet (January 4 issue), says these seriously ill children will do just as well at home on antibiotic syrup:

Researchers arrived at these conclusions based on their study of 2,037 children aged between three and five years in Pakistan. In their study, researchers looked at children with severe pneumonia in Pakistan, who came for treatment to hospitals in seven locations.

The hospitals sent half of the sick children back and asked them to take amoxicillin, an antibiotic, orally in syrup form. The remaining half were kept at the hospitals and provided with an intravenous version of an antibiotic that worked more or less the same - ampicillin. (Money Times)

The results showed no difference:

The study found 87 (8.6%) treatment failures in the hospitalized group, and 77 (7.5%) in the group treated at home. Of the five children (0.2%) who died during the study, four were in the hospitalized group and one was at home. (Boston University Press Release)

It has been estimated that almost four children die of pneumonia every minute. In the developing world many can't get to a hospital because of cost or distance. Staying out of a hospital also prevents exposure to other diseases and hospital infections. Instead of trying to get the children to the hospitals a better strategy would be to try to get the antibiotics to the children.

So what implication does this have for an influenza pandemic? That's harder to say. The corresponding author of the Boston University study observes that 60% of pneumonias in the developing world are caused by bacteria, for which antibiotics like amoxicillin are effective, compared to most pneumonias in the developed world which are of viral origin. Influenza, of course, is a virus but serious complications often are caused by secondary bacterial infections.

If there is a major influenza pandemic we won't have to decide what to do. Medical facilities will be overwhelmed and most cases will have to be cared for at home or at least out of the hospital, perhaps in a make-shift or temporary clinical facility. Either way we should plan to get oral antibiotics to where the patients are.

If it works in Pakistan, it ought to work in Peoria.