Antibiotic use in infants hospitalised with HIV-related pneumonia in Harare, Zimbabwe
1Department of Paediatrics and Child Health Medical School, University of Zimbabwe, PO Box A 178, Avondale, Harare, Zimbabwe. ichitsike@healthnet.zw
Insights
Infants with HIV-related pneumonia often receive suboptimal antibiotic treatment, leading to high mortality rates. Establishing a clinical case definition for Pneumocystis pneumonia could improve care and antibiotic use in resource-limited settings.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- HIV infection significantly increases the risk of pneumonia in infants.
- Pneumonia is a leading cause of mortality in infants, particularly those with HIV.
- Adherence to treatment guidelines for HIV-related pneumonia is crucial for improving outcomes.
Purpose of the Study:
- To characterize the clinical presentation of infants hospitalized with HIV-related pneumonia.
- To evaluate antibiotic prescribing patterns against established treatment guidelines.
- To identify factors contributing to mortality in this vulnerable population.
Main Methods:
- A case series design was employed, analyzing records of 100 infants (1-12 months) admitted with HIV-related pneumonia.
- Data collected included clinical features, antibiotic administration, and treatment adherence to the Essential Drug List of Zimbabwe (EDLIZ).
- Mortality rates were compared between two university teaching hospitals.
Main Results:
- The majority of infants (77%) were under six months old, with a median age of four months.
- Only 30% of antibiotic prescriptions complied with EDLIZ recommendations for severe pneumonia in HIV-infected children.
- The overall mortality rate was 27%, with significantly higher mortality observed in Harare Central Hospital (40.4%) compared to Parirenyatwa Hospital (15.7%).
Conclusions:
- Challenges in diagnosing the specific cause of pneumonia in HIV-infected infants contribute to poor adherence to treatment guidelines.
- Implementing a clinical case definition for Pneumocystis pneumonia (PCP) is recommended for resource-limited settings to guide evidence-based treatment.
- A standardized approach to PCP diagnosis and treatment can promote rational antibiotic use and reduce healthcare costs.
Objective:
To describe the clinical features of infants admitted with HIV-related pneumonia and to describe antibiotic use in relation to recommended treatment guidelines.
Design:
Case series.
Setting:
Paediatric medical wards of two University Teaching Hospitals, Parirenyatwa and Harare Central Hospitals.
Subjects:
100 infants aged one to 12 months admitted with HIV-related pneumonia.
Main Outcome Measures:
Mortality and antibiotic use in the two hospitals.
Methods:
Records of 100 infants admitted for 48 hours or more with features of HIV-related pneumonia were analysed for clinical features and antibiotic use.
Results:
77% of patients were in the first six months of life with a peak age of two months and a median of four months (Q1 = 2, Q3 = 6). The median age of children admitted to Parirenyatwa hospital was 5.5 months (Q1 = 3, Q3 = 7) and in Harare hospital it was three months (Q1 = 2, Q3 = 6). The difference was statistically significant, p = 0.035. Fifty four percent of cases received penicillin, aminoglycoside and cotrimoxazole and overall only 30% of prescriptions complied with Essential Drug List of Zimbabwe (EDLIZ) recommendations for treatment of severe pneumonia in children with HIV infection. The overall mortality was 27.0%. The mortality in Harare Central Hospital was 40.4% and 15.7% in Parirenyatwa. The difference was statistically significant p = 0.005.
Conclusion:
The difficulties in establishing the cause of the pneumonia in infants with HIV infection was a contributory factor to lack of adherence to standard treatment guidelines. In countries with a high prevalence of HIV infection and with limited resources, a clinical case definition for Pneumocystis carinii pneumonia (PCP) is required as a measure to provide treatment for infants with HIV related pneumonia which is evidence based. This approach will also promote rational antibiotic prescribing and will contain cost.
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