New study says kids with severe pneumonia can be treated at home

A new study — published in Friday’s issue of British Medical Journal Lancet...

A new study — published in Friday’s issue of British Medical Journal Lancet — says that children with severe pneumonia can be treated as effectively at home as in a hospital. “The finding that oral treatment outside a hospital is safe and efficacious is a milestone and should change the management of severe pneumonia in children in developing countries,” says the journal. The study was conducted by researchers of Boston University’s School of Public Health at seven sites across Pakistan. Researchers opined that treating children with severe pneumonia at home would also save money.

Pneumonia kills more children than any other disease — more than AIDS, malaria and measles combined. It causes almost one in five out of the under-five deaths worldwide and the death of more than 2 million children each year. In India, the number of cases is the highest, which calls for a discussion among the experts on the management of the disease.

While, the study has forced the international health agencies to work on the existing guidelines, doctors in India beg to differ on the treatment of the disease.

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According to the study, doctors in Pakistan randomly assigned children with serious pneumonia to either receive antibiotic shots in the hospital for two days, or to take antibiotics at home for five days. Parents of the children sent home were instructed how and when to give their children the antibiotics. The experts found that children taking antibiotics at home were as likely to survive serious pneumonia as those treated in hospitals. While 1,012 children were hospitalised, 1,025 were treated at home. The children were aged between about three months and five years.

Among the hospitalised children, 87 children did not respond to the treatment or developed complications. Seventy-seven children — who were treated at home — did not respond to the treatment. Five children died during the study, which includes four of the hospitalised and one was among those receiving treatment at home.

While the current WHO guidelines recommend that children with non-severe pneumonia be treated at home with oral antibiotics, they recommend those with severe pneumonia be referred to hospital. Based on the recent study, it is learnt that WHO may revise its guidelines for children with pneumonia.

Experts in India, however, say that it is not a foolproof study.

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“This is not a multi-centric trail. One has to take clinical, radiological and laboratory based criteria. Children with pneumonia definitely require hospitalisation till there are initial signs of clinical improvement. The total duration of treatment in the hospital and at home is not less than five to seven days. Apart from acute gastroenteritis, acute respiratory infections are the leading causes of death in the Indian subcontinent,” said Dr Sanjeev Bagai, director and HOD, pediatrics, Rockland Hospital.

“Good oral antibiotics are available. But in severe cases hospitalisation is necessary,” said a pediatrician at Lok Nayak hospital.

Experts also believe that the study needs to be replicated in the Indian context.

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