Community-based treatment of severe childhood pneumonia

Abstract

In 2010, an estimated 7·6 million children died before their fi fth birthday, and more than a million of these deaths were due to pneumonia. Although progress is being made in expanding the use of vaccines to prevent pneumonia, many countries have yet to introduce these vaccines, especially the pneumococcal vaccine. Correct breastfeeding of children can also help prevent pneumonia deaths, but a high prevalence of suboptimum breastfeeding practices (eg, low rates of exclusive breastfeeding up to 6 months of age) is seen in all regions of the world. Reduction of zinc defi ciency and reduction of exposure of children to high concentrations of smoke could also reduce the risk of pneumonia, but intervention programmes to address these problems have not been suffi ciently implemented. Treatment is, therefore, the mainstay of pneumonia control programmes in most high-mortality countries, mainly through implementation of the Integrated Management of Childhood Illness (IMCI) guidelines. For pneumonia, IMCI guidelines recommend the treatment of non-severe pneumonia at home with oral cotrimoxazole or amoxicillin, and referral to hospital for children presenting with cough or diffi culty breathing who also have chest indrawing (severe pneumonia) or stridor or danger signs (very severe pneumonia). However, in many settings, referral completion rates are too low to result in correct treatment in most cases. In 2008, an observational study in Bangladesh and a randomised controlled trial in Pakistan showed that children aged 2–59 months who have severe pneumonia but no signs of very severe pneumonia can be safely and eff ectively treated at home with oral amoxicillin after diagnosis in health facilities. In The Lancet, Sajid Soofi and colleagues report on the eff ectiveness of oral amoxicillin for the treatment of severe pneumonia in rural Pakistan, building on drugs, this study provides timely clarifi cation of the toxicity associated with lithium therapy and, on balance, re affi rms its role as a treatment of choice for bipolar disorder.