Treatment Of Pneumonia In Children Research Articles

Meta-analysis of the efficacy of budesonide and ambroxol hydrochloride inhalation in children with pneumonia and their effects on inflammatory response

Childhood pneumonia, often caused by acute upper respiratory tract infections or bronchitis, is one of the leading causes of mortality in children. Nebulized inhalation, as a low-risk treatment method, has garnered significant attention. However, its effectiveness and safety remain controversial. In this study, a systematic review of relevant literature on the use of budesonide (BUD) and ambroxol hydrochloride (AMB) inhalation in the treatment of childhood pneumonia was conducted, and a total of 10 articles were included. The meta-analysis revealed an odds ratio (OR) of 1.61 and an I2 value of 0.00 % for the effectiveness of combined BUD and AMB inhalation therapy in children with pneumonia, indicating no heterogeneity among the studies in terms of effectiveness. The OR values for BUD or AMB inhalation in alleviating cough, lung auscultation abnormalities, respiratory distress, body temperature, and cyanosis of the lips in children with pneumonia all favored the combined BUD therapy, showing significant relief of the aforementioned symptoms. However, due to variations in drug dosage and administration methods, high heterogeneity was observed. This study suggested that combined BUD and AMB inhalation therapy has better efficacy in treating childhood pneumonia, and BUD combined with AMB inhalation is more effective in alleviating symptoms such as cough, lung auscultation abnormalities, respiratory distress, normalizing body temperature, and reducing cyanosis of the lips. Nevertheless, further validation is required due to the limited sample size and substantial heterogeneity in the included studies. To sum up, this study provides the first analysis of the efficacy and inflammatory response of BUD and AMB inhalation in children with pneumonia. Future research should aim to verify and clarify these findings, considering the limitations of the existing studies in terms of sample size and heterogeneity.

Treatment and Diagnostic Problems of Pneumonia in Children

Pneumonia in children is one of the most common, serious, potentially life-threatening diseases. The criteria for the diagnosis and treatment of pneumonia have been developed a long time ago and are clearly formulated. However, one has to deal with underdiagnosis and irrational therapy, which is observed more often at the outpatient stage. A comparative analysis of recommendations published recently in a number of countries on the diagnosis and treatment of pneumonia in children was carried out. We studied the timeliness of diagnosis and the adequacy of therapy at the outpatient stage in 167 hospitalized children with pneumonia.

Efficacy Of Vibroacoustic Therapy In Treatment Of Pneumonia In Children With Bronchopulmonary Dysplasia

Background — Advances in neonatal intensive care have resulted in high survival rates for infants born with extremely low birth weight. Accordingly, the treatment and rehabilitation of premature neonates with bronchopulmonary dysplasia (BPD) is indisputably an urgent problem. Objective — To evaluate the efficacy of vibroacoustic therapy in patients with BPD in the complex of therapeutic measures. Material and Methods — The study was a prospective, non-randomized open-label controlled clinical trial conducted in 2018-2020 in Astana, Kazakhstan. It included 69 children with BPD hospitalized with a concomitant diagnosis of pneumonia between the ages of 1 and 2 years. The study subjects were distributed among two groups: Group 1 (the main group, n=37) receiving vibroacoustic therapy with the VibroLung apparatus in combination with the main treatment and Group 2 (the control, n=32) receiving solely the main treatment. Results — The inclusion of the vibroacoustic method of treatment in the combination therapy of pneumonia in children with BPD resulted in early leveling of the following clinical symptoms: a reduction in the duration of the high fever by 1.18 days vs. the control group (p<0.05), relief of respiratory failure 1.4 days earlier vs. the control group (p<0.05) and a decrease in the duration of inpatient treatment by 2.9 days, compared with the control group (p<0.05). All of these implied the efficacy of this treatment method. Conclusion — Our results demonstrated that vibroacoustic therapy was a relevant addition to the treatment of pneumonia in children with BPD.

Можливості верифікації позагоспітальної пневмонії в дітей за змінами багатопараметричної поляризаційно-фазової мікроскопії полікристалічних плівок легеневого експірату

The problem of early diagnosis and selection of target treatment of pneumonia in children during the years of the COVID-19 pandemic became acute, in particular, with regard to predicting the risk of severe disease, which prompted the search for new non-invasive diagnostic methods for verifying inflammation of the lung parenchyma. Purpose - to increase the effectiveness of the diagnosis of community-acquired pneumonia in children based on the analysis of the diagnostic value of the method of multiparameter polarization-phase microscopy of polycrystalline membranes of pulmonary expiratory condensate in the aspect of differential diagnosis in relation to patients with infectious inflammatory diseases of the upper respiratory tract. Materials and methods. In the Chernivtsi Regional Pediatric Hospital, 98 children with infectious inflammatory respiratory diseases were examined, in particular, 64 patients with pneumonia and 34 children suffering from infectious and inflammatory diseases of the upper respiratory tract. Biological material was collected from patients on the first day of hospitalization. The investigation of the laser-polarimetric images structure of pulmonary expiratory condensate was carried out in the traditional arrangement of the Stokes polarimeter. A universal analytical statistical approach was used for each two-dimensional distribution of the polarization azimuth values of the polycrystalline membranes of pulmonary expiratory condensate, namely, the determination of a set of statistical moments of the 1st to 4th orders (mean, variance, skewness and kurtosis). The obtained results were analyzed using methods of clinical epidemiology. Results. Polarization azimuth indexes and histograms of their values were determined for images of pulmonary expiratory samples of both groups of children. The comparative analysis of the obtained data confirmed that both samples are characterized by optical heterogeneity as an increase in the sensitivity of polarization mapping of lung expiratory samples. An increase in the optical anisotropy of polycrystalline membranes of lung expiratory condensate from patients with pneumonia was also revealed. The obtained indexes of all statistical moments for the purpose of pneumonia verifying had high sensitivity exceeding 98% and sufficient specificity. Conclusions. Sufficient diagnostic value of the method of multi-parameter polarization-phase microscopy of pulmonary expiratory air, which can be used in the verification of inflammation of the pulmonary parenchyma in children relative to patients with infectious inflammatory diseases of the upper respiratory tract, has been established. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Analyzing the epidemic situation and influencing factors of childhood pneumonia during the COVID-19 epidemic period in Laiwu, China.

This study aimed to analyze the trends of childhood pneumonia before and after the corona virus disease 2019 (COVID-19) pandemic in Laiwu, China, and explore the associated risk factors to provide a reference for the prevention, control, and treatment of childhood pneumonia. In this cross-sectional study, data were collected from 11,716 children aged 3 to 12 years who underwent chest radiography/computed tomography from January 2018 to December 2021 in Laiwu, China. The generalized estimating equation model was used to analyze the time trend of the pneumonia detection rate. Multivariate logistic regression analysis was used to analyze the risk factors for pneumonia in children. The overall pneumonia detection rate was 40.3% (4721/11,716). The pneumonia detection rate was 41.5% and 39.5% in 2018 and 2019, respectively, before the COVID-19 pandemic, which decreased to 38.1% in 2020 during the pandemic and increased to 40.7% in 2021 after the pandemic. Multivariate logistic regression analysis showed that preterm birth (odds ratio [OR] = 1.68), frequent exposure to secondhand smoke (OR = 1.79), hospitalization ≥ 1 time in half a year (OR = 2.13), and history of allergic rhinitis (OR = 2.14) were risk factors for pneumonia in children. Wearing masks when outdoors (OR = 0.89) and engaging in regular physical activity (OR = 0.65) were protective factors. The pneumonia detection rate in children showed a decreasing trend during the COVID-19 pandemic in 2020 but an increasing trend after the pandemic in 2021. Premature birth, exposure to secondhand smoke, frequent hospitalization, and allergic rhinitis were risk factors for pneumonia in children. Wearing masks when outdoors and exercising may reduce the risk of pneumonia in children.

Diagnosis and treatment of pneumonia in children

Early diagnosis and rational therapy pneumonia in children is an urgent task of pediatrics. For diagnosing a bacterial infection, especially a severe one, assessing the appearance and behavior of the child is much more important than reading a thermometer [6,7]. Signs that allow to assess the severity of intoxication, common with a bacterial infection, include a rapid disturbance violation of the general condition, a decrease in the activity of the child; irritability (screaming when touched), lethargy, drowsiness (sleep longer), lack of eye contact of the child during examination, the child refuses to eat and drink. The severity of the condition is determined by the severity of tachycardia, muffled heart sounds, hypo- or hyperventilation, cough, dyspnea, bronchophony and local rales, violation of microcirculation, peripheral cyanosis, incessant vomiting. Amoxicillin is effective against most of the pathogens that cause communityacquired pneumonia. Patients in the presence of underlying diseases or taking antibiotics in the previous 3 months are prescribed amoxicillin / clavulanate in monotherapy or in combination with macrolides (azithromycin, clarithromycin). Macrolides should also be used when mycoplasma or chlamydial pneumonia is suspected

Comparing the return on investment of technologies to detect substandard and falsified amoxicillin: A Kenya case study.

The prevalence of substandard and falsified medicines in low- and middle-income countries (LMICs) is a major global public health concern. Multiple screening technologies for post-market surveillance of medicine quality have been developed but there exists no clear guidance on which technology is optimal for LMICs. This study examined the return on investment (ROI) of implementing a select number of screening technologies for post-market surveillance of amoxicillin quality in a case study of Kenya. An agent-based model, Examining Screening Technologies using Economic Evaluations for Medicines (ESTEEM), was developed to estimate the costs, benefits, and ROI of implementing screening technologies for post-market surveillance of substandard and falsified amoxicillin for treatment of pediatric pneumonia in Kenya. The model simulated sampling, testing, and removal of substandard and falsified amoxicillin from the Kenyan market using five screening technologies: (1) Global Pharma Health Fund's GPHF-Minilab, (2) high-performance liquid chromatography (HPLC), (3) near-infrared spectroscopy (NIR), (4) paper analytical devices / antibiotic paper analytical devices (PADs/aPADs), and (5) Raman spectroscopy. The study team analyzed the population impact of utilizing amoxicillin for the treatment of pneumonia in children under age five in Kenya. We found that the GPHF-Minilab, NIR, and PADs/aPADs were similar in their abilities to rapidly screen for and remove substandard and falsified amoxicillin from the Kenyan market resulting in a higher ROI compared to HPLC. NIR and PADs/aPADs yielded the highest ROI at $21 (90% Uncertainty Range (UR) $5-$51) each, followed by GPHF-Minilab ($16, 90%UR $4 - $38), Raman ($9, 90%UR $2 - $21), and HPLC ($3, 90%UR $0 - $7). This study highlights screening technologies that can be used to reduce costs, speed up the removal of poor-quality medicines, and consequently improve health and economic outcomes in LMICs. National medicine regulatory authorities should adopt these fast, reliable, and low-cost screening technologies to better detect substandard and falsified medicines, reserving HPLC for confirmatory tests.

MHealth platform improved health worker's compliance to WHO’s IMNCI guideline in Nairobi, Kenya

Abstract Poor access to quality health services, especially in urban slums, is a global challenge. Given similar challenges in Nairobi's Kibra informal settlement area, we collaborated with the Langata/Kibra sub-county health management team to conduct a pilot program for improving the quality of child health services delivered by health care providers (HCPs). The pilot introduced a digital mHealth platform to HCPs working in Kibra informal settlement area in Nairobi. This mHealth platform was compliant to WHO's recommended guideline for integrated management of newborn and child illnesses (IMNCI) and was designed to help sick child assessment, diagnosis and management by HCPs. We aimed to determine if using this digital platform, coupled with supportive supervision and community outreach, would lead to improve compliance to the IMNCI guideline for assessment, diagnosis and treatment of sick children. We conducted baseline (February 2019) assessment, trained selected HCPs on the mHealth platform on handheld android tablets, conducted end line (March 2020) and measured any change in HCP's compliance to IMNCI guidelines. Total 89 HCPs were the mHealth platform users during end line assessment. When asked about the choice of antibiotic for treating childhood pneumonia, we found proportion of HCPs who preferred Amoxycillin dispersible tablet, the recommended treatment for childhood pneumonia, increased from 3% at baseline to 38% at end line. Proportion of HCPs who were aware that antibiotics should NOT be used for the management of simple diarrhea increased from 14% (at baseline) to 50% (at end line). At end line, more than 90% HCPs were found compliant in their practice to IMNCI guidelines for sick child assessment, diagnosis and management. These results demonstrate the use of the IMNCI compliant mHealth platforms as a potential important effective way to improve capacity and compliance among HCPs who are serving communities like Kibra informal settlement in Nairobi, Kenya. Key messages • WHO recommended IMNCI compliant mHealth platform enables health care providers to offer quality child health care. • Using mHealth platform to ensure WHO’s IMNCI guideline implementation by health care providers might have potential impact on saving sick children’s lives from preventable deaths.

Impact of preventive and early treatment of childhood pneumonia and diarrhea in Ethiopia, analysis from Health Management Information System (HMIS) report 2010 -2016

Background: In Ethiopia mortality in children younger than five years it has dropped from 202 in 1990 to 55 in 2019 (EDHS 2019). Pneumonia and diarrhea are the two leading causes of under-five mortality. They have overlapping risk factors, such as poverty, undernutrition, and poor hygiene. Ethiopia introduced Integrated Community Case management (ICCM) is strategy to treat sick children in communities. Pneumococcal Conjugate vaccine was introduced in 2010, and Rotavirus vaccine was in 2013.This research was conducted to assess the changes in morbidity and mortality in children due to pneumonia and diarrhea based on HMIS data. Methodology: Diarrhea and pneumonia morbidity, admission, and mortality data of under five children were extracted from 2002/09 EFY to 2008/16 GC, annual Federal Ministry of Health and Health related indicators bulletin. Proportion of morbidity, admission, mortality, and change in percentage analyzed and compared using significant test. Results: Morbidity due to pneumonia to total under five morbidity increased from 2.6% to 8.7%, and that of diarrhea from 2.3% to 11.8% in six years (2010 to 2016) p-0.000. Admission due to pneumonia decreased from 5% to 4.5%, (10% reduction), p-0.009 and that of diarrhea 3.4%, to 1.3%, (63% reduction), p-0.000. Mortality due pneumonia decreased from 2.7%, to 1.4 %, (48% reduction), p-0.113, that of diarrhea decreased from 1.9% to 0.9%, (53% reduction), p-0.42. The change in morbidity and admission were significant, but that of mortality was not significant. Conclusion: The increase in morbidity of pneumonia and diarrhea might be due to increase in health service utilization. The decline in admission and mortality of both diseases showed that introduction of new vaccines of, Rota, and early treatment in health posts using ICCM algorisms, have significant contribution. Standard quality treatment, prevention by improving immunization quality and coverage, maximum utilization of health service, is necessary to further decrease, admission and mortality.

Shen-Ling-Bai-Zhu-San Enhances the Antipneumonia Effect of Cefixime in Children by Ameliorating Gut Microflora, Inflammation, and Immune Response.

Objective Shen-Ling-Bai-Zhu-San (SLBZS) is used for treating gastrointestinal disorders. However, the role of SLBZS in treating pneumonia in children is still unclear. Methods In this study, children (≥2 and <9 years) with pneumonia were treated with 0.1 g cefixime (cefixime group) or 0.1 g cefixime + 9 g SLBZS (SLBZS + cefixime). The drugs were administered twice daily for 10 days. The therapeutic effects of the two groups were compared. The white blood cell (WBC), neutrophil, and lymphocyte counts; neutrophil-lymphocyte ratio (NLR); serum inflammatory factor levels; and gut microflora were assessed. Results The clinical efficacy of SLBZS + cefixime treatment of pneumonia in children was higher than that of cefixime alone (93.3% vs. 86.7%). Both cefixime and SLBZS + cefixime treatments decreased the area of pulmonary inflammatory lesions, reduced white blood cell and neutrophil counts, neutrophil-lymphocyte ratio, inflammation, and increased lymphocyte count in children with pneumonia compared with those before treatment. Moreover, SLBZS enhanced the anti-inflammation and immunity-enhancing effects of cefixime in children with pneumonia. SLBZS + cefixime treatment decreased Enterobacter, Enterococcus, Bacteroides, and Fusobacterium counts and increased Bifidobacterium and Lactobacillus counts. Compared with the cefixime treatment group, the count of the six bacterial strains in the SLBZS + cefixime treatment group was closer to the normal level. Conclusion SLBZS enhanced the antipneumonia effect of cefixime in children with pneumonia by ameliorating gut microflora, inflammation, and immune response.

No difference between length of antibiotic course for treatment of pneumonia in children, meta-analysis finds

A shorter course of antibiotics is as effective as a longer course in children with non-severe community-acquired pneumonia (CAP), an analysis of nine randomised controlled trials (RCTs) has concluded. The systematic review and meta-analysis, published in JAMA Pediatrics on 14 November 2022, comprised nine RCTs comparing a shorter course (e.g. three days vs. five to […]

NATIONAL ASSESSMENT OF PNEUMONIA MORBIDITY IN CHILDREN IN THE PERIOD 1993-2017 AND PROGNOSIS FOR 2025.

The aim: To assess national trends in the morbidity of pneumonia in children aged 0-6 years, 7-14 years and 15-17 years in the period from 1993 to 2017 and mathematically predict the dynamics of the morbidity in 2025. Materials and methods: Data from the Center for Medical Statistics of the Ministry of Health of Ukraine for the period 1993-2017 were used to calculate the morbidity rate of pneumonia in children aged 0-6 years, 7-14 and 15-17 years. Result: The period from 1993 to 2017 is characterized by high incidence of pneumonia in children in Ukraine (from 6.74 to 8.21 per 1000). In children aged 0-6 years, the morbidity 1000 ranged from 11.45 to 11.17, in children aged 7-14 years - from 4.65 to 6.46, in adolescents aged 15-17 years - from 1.99 to 10.47 . In Ukraine, the morbidity rate has significantly exceeded the that in European countries. In 2025, the morbidity of children under 6 years old in Ukraine may make up 3.84 per 1,000. Conclusions: In Ukraine, a significant increase in the morbidity rate of pneumonia in adolescents is predicted by 2025. It is necessary to develop a national strategy to improve the health of children and adolescents to implement policy and management measures in the health care system, aimed at effective prevention and quality treatment of pneumonia in children and adolescents.

Pharmaco-economic features of hospital treatment of acute community-acquired pneumonia in children

The goal. Тo analyze the features of treatment and medical expenses in children hospitalized for acute community-acquired pneumonia. Materials and methods. The study analyzed medical records and examined 51 children aged 2 to 17 months hospitalized for pneumonia. In patients studied clinical symptoms, severity, structure and duration of basic treatment measures, their cost. Results. The duration of inpatient treatment was 13.3±0.62 days with subsequent outpatient treatment and rehabilitation. Antibiotics, antipyretics, antihistamines, mucolytics and corticosteroid hormones were used in the treatment. The total cost of treatment for one case averaged 2346.9±145.7 hryvnias. The most expensive were the costs of antibiotics, and the cheapest - the antipyretics. Given the community-acquired nature of the process, the initial use of third- and fourth-generation cephalosporins was irrational and significantly increased the cost of treatment. Conclusions. The introduction of a new model of medicine focuses on the optimization of treatment tactics and the rational choice of antibiotics for acute community-acquired pneumonia. In antibacterial therapy is still inadequate, from a clinical and economic point of view, the choice of drugs. In the treatment of this disease, the role of pathogenetic therapy to restore the processes of mucociliary clearance and prevention of dysbiosis on the background of the use of antibiotics has increased.

Vitamin C supplementation for prevention and treatment of pneumonia.

According to the Global Burden of Disease Study 2015, lower respiratory tract infection is the leading cause of infectious disease death, and the fifth most common cause of death overall. Vitamin C has a role in modulating resistance to infectious agents, therefore vitamin C supplementation may be important in preventing and treating pneumonia. To assess the impact of vitamin C supplementation to prevent and treat pneumonia in children and adults. We searched CENTRAL, MEDLINE, Embase, PubMed, CINAHL, LILACS, Web of Science, and two trials registers to 4 March 2020. We also checked references to identify additional studies. We did not apply any publication status or language filters. We included randomised controlled trials (RCTs) and quasi-RCTs (studies using allocation methods that are not random, e.g. date of birth, medical record number) assessing the role of vitamin C supplementation in the prevention and treatment of pneumonia in children and adults compared to control or placebo. We used standard methodological procedures expected by Cochrane. We included five studies in the review and identified two ongoing studies. The five included studies involved a total of 2655 participants; two studies were RCTs and three were quasi-RCTs. The included studies were conducted in one high-income country (USA) and three lower-middle-income countries (Bangladesh and Pakistan). Three studies were conducted in hospital inpatient settings, one in school, and one in a military training centre. Three studies included children under five years of age, one study included school-aged children, and one study included adult participants. Two studies assessed the effect of vitamin C supplementation for pneumonia prevention; and three studies assessed the effect of vitamin C supplementation as an adjunct to pneumonia treatment. For pneumonia prevention, the included studies provided supplementation in doses of 1 g daily for 14 weeks, 2 g daily for 8 weeks, and 2 g daily for 14 weeks. For pneumonia treatment, the included studies provided vitamin C supplementation in doses of 125 mg daily and 200 mg daily until the symptoms resolved or discharge, as an adjunct to the pneumonia treatment. Overall, the included studies were judged to be at either high or unclear risk of bias for random sequence generation, allocation concealment, and blinding; and the evidence certainty was very low. Two studies assessed the effect of vitamin C supplementation for pneumonia prevention; we judged the certainty of the evidence as very low. We are uncertain about the effect of vitamin C supplementation on pneumonia incidence and adverse events (urticaria). None of the included studies reported other primary outcomes (pneumonia prevalence and mortality) or any of the secondary outcomes. Three studies assessed the effect of vitamin C supplementation as an adjunct to pneumonia treatment; we judged the certainty of the evidence as very low. We are uncertain of the effect of vitamin C supplementation on duration of illness and hospitalisation. None of the included studies reported other primary or secondary outcomes. Due to the small number of included studies and very low certainty of the existing evidence, we are uncertain of the effect of vitamin C supplementation for the prevention and treatment of pneumonia. Further good-quality studies are required to assess the role of vitamin C supplementation in the prevention and treatment of pneumonia.

THE SITUATION OF ANTIBIOTIC TREATMENT OF COMMUNITY PNEUMONIA IN CHILDREN

Objective: To investigate the situation of antibiotic use in the treatment of community pneumonia in children at Can Tho Children’s Hospital. Subjects and methods: Retrospective-descriptive study on 140 children diagnosed with community pneumonia, hospitalized for treatment at Can Tho Children’s Hospital from October 2020 to December 2020. Results: 55.71% of patients were taking antibiotics before hospitalization. Antibiotics used the most to treat pneumonia at hospital were penicillins/betalactamse inhibitors, accounting for 44.44%. For pneumonia patients, the rate of choosing the single regimen for initial treatment was 89.47% and the combination regimen was 10.53%. For patients with severe pneumonia, the rate of choosing of single regimen had decreased to 74.14%, while the choice of combination regimen had increased to 25.83%. The average number of regimen changes during treatment was 1.43 ± 056 times. The main reason for the change in the regimen was improved clinical symptoms (43.75%). The average duration of treatment with antibiotics was 6.48 ± 0.71 days. The duration of treatment as well as the duration of antibiotic use increased with the severity of the disease. Conclusion: The most commonly used antibiotics for treating commnity pneumonia at hospital were penicillins/betalactamse inhibitors. For pneumonia patients, a single regimen (89.47%) and a combination regimen (10.53%) was chosen. For patients with severe pneumonia, the choice of the single regimen decreased to 74.14%, the combination regimen increased to 25.83%. The main reason for the modification of the regimen was the improvement of clinical symptoms. The duration of treatment as well as the duration of antibiotic use increased with the severity of the disease.

Оптимізація комплексної терапії пневмоній у дітей, які часто хворіють на гострі респіраторні захворювання

Purpose — to improve the pathogenetic treatment of pneumonia in children with recurrent acute respiratory infections by combining of protocol therapy with a drug has antioxidant, antihypoxic and organoprotective effects. Materials and methods. The analysis of the results of clinical, laboratory and instrumental methods of examination of children with pneumonia at the age of 3–8 years which have recurrent acute respiratory infections has performed. Children have had received standard protocol treatment of pneumonia and combination with a drug has antioxidant, antihypoxic and organoprotective effects. Results. Optimization the protocol treatment of pneumonia in children with recurrent acute respiratory infections by supplementing pathogenetic therapy with this drug made possible to improve the efficiency of treatment, what confirmed by the rapid regression of clinical manifestations of pneumonia (intoxication — to 1.9±0.04 days, cough — to 2.1±0.08 days, respiratory failure — to 1.7±0.08 days, shortness of breath — to 1.3±0.04 days, disorders of microcirculation and hemodynamics — to 2.1±0.05 and 1.8, respectively ± 0.09 days). This approach calls the decrease of percentage of children with pneumonic infiltration according to the control X-ray examination of the lungs — to 30.0%, myocardial hypoxia according to the ECG results — 20.0%, which made possible to reduce the duration of the course of antibiotic therapy to 2.0±0.04 days, inpatient treatment — to 2.2±0.08 bed-days. The positive dynamics laboratories values, clinical signs and instrumental methods of examination of such children occurred due to an increasing levels of glutathione reductase and glutathione transferase in the blood serum to 4 and 3 times, respectively, and a decreasing the content of glutathione peroxidase and gamma$glutamyl transpeptidase to 2.6 and 1.6 times. Conclusions. Supplement the protocol therapy of pneumonia in children with recurrent acute respiratory infections with a drug has antioxidant, antihypoxic and organoprotective effects promoted a rapid regression of clinical manifestations due to the improvement of the functional activity of the oxidative system of glutathione, which made possible to reduce the duration of the course of antibiotic therapy and inpatient treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: children with recurrent acute respiratory infections, pneumonia, treatment.

Место азитромицина в лечении внебольничной пневмонии у детей

На фоне растущей резистентности бактерий к антибактериальным препаратам лечение пневмонии остается актуальным вопросом медицины. В статье приведены международные рекомендации по применению антибиотиков при лечении внебольничной пневмонии у детей. В многочисленных экспериментальных и клинических исследованиях выявлена высокая эффективность азитромицина даже при наличии резистентных штаммов. Это обусловлено особенностями фармакокинетики, фармакодинамики и многогранностью механизмов действия препарата. На сего-дняшний день азитромицин не утратил своих позиций в лечении внебольничной пневмонии, особенно в педиатрической популяции.

Barriers to seeking timely treatment for severe childhood pneumonia in rural Bangladesh

ObjectiveDelays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood...

Fluoroquinolone and no risk of Achilles-tendinopathy in childhood pneumonia under eight years of age-a nationwide retrospective cohort.

BackgroundThe emergence of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMP) has made its treatment challenging. A few guidelines have recommended fluoroquinolones (FQs) as second-line drugs of choice for treating MRMP in children under the age of eight, but concerns about potential adverse events (i.e., Achilles tendinopathy; AT) have been raised. The aim of this study was to investigate the relationship between the use of FQs and the risk of AT in pneumonia in children under eight years of age.MethodsChildren hospitalized with pneumonia (total of 2,213,807 episodes) from 2002 to 2017 were enrolled utilizing the Korean National Health Insurance Sharing Service (NHISS) database. The independent risk of FQs for AT was analyzed by a generalized estimating equation with adjustment for age, sex, and underlying diseases.ResultsAmong 2,213,807 episodes of pneumonia hospitalization, children in a total of 6,229 episodes (0.28%) were treated with FQs (levofloxacin 40.9%, ciprofloxacin 36.1%, moxifloxacin 11.6%, and others 11.4%). The FQ-exposure group showed a 0.19% (12/6,229) incidence of AT within 30 days after the first administration of FQ. The use of FQs increased the risk of AT (OR 3.00; 95% CI: 1.71–5.29), but became null after adjusting for age, sex, and underlying diseases (aOR 0.85; 95% CI: 0.48–1.51). All AT related to the use of FQs occurred after the use of ciprofloxacin or levofloxacin, and not in children under eight years of age.ConclusionsAT was a rare adverse event of FQ use for childhood pneumonia, particularly under eight years of age. Clinicians could consider using FQs as a second-line option in the treatment of childhood pneumonia when there are no alternative therapeutic options.

Rightsizing Treatment for Pneumonia in Children

Rightsizing Treatment for Pneumonia in Children