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Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia
Published on: May 6, 2014
Recommendations for treatment of childhood non-severe pneumonia
Gavin B Grant1, Harry Campbell, Scott F Dowell
1National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. gbgrant@cdc.gov
Insights
Updated WHO guidelines recommend amoxicillin as the first-line treatment for childhood pneumonia, aiming to reduce mortality. New recommendations address antimicrobial resistance and emerging pathogens in pediatric pneumonia care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- WHO antimicrobial treatment guidelines for childhood pneumonia require updating after over a decade.
- Emerging antimicrobial resistance, novel pneumonia pathogens, and new drugs necessitate revised evidence-based recommendations.
- Current guidelines focus on reducing childhood mortality through effective pneumonia management.
Purpose of the Study:
- To review existing literature on childhood pneumonia.
- To develop updated, evidence-based recommendations for empirical treatment of non-severe childhood pneumonia.
- To guide first-level health providers in managing pediatric pneumonia effectively.
Main Methods:
- Convened an international panel of experts.
- Conducted a comprehensive literature review on childhood pneumonia.
- Developed recommendations for empirical treatment targeting common bacterial pathogens like Streptococcus pneumoniae and Haemophilus influenzae.
Main Results:
- Amoxicillin is recommended as the optimal first-line treatment for non-severe childhood pneumonia, administered twice daily for 3-5 days.
- Co-trimoxazole is suggested as an alternative first-line agent in specific contexts.
- Treatment failure is defined by persistent symptoms or lack of respiratory rate improvement after 48-72 hours, prompting investigation into adherence or alternative diagnoses.
Conclusions:
- Updated guidelines prioritize amoxicillin for first-line empirical treatment of non-severe childhood pneumonia.
- High-dose amoxicillin-clavulanic acid or amoxicillin with a macrolide are recommended second-line options for treatment failure in children over 3 years.
- Revised recommendations aim to improve outcomes and address evolving challenges in pediatric pneumonia management.
Abstract:
WHO recommendations for early antimicrobial treatment of childhood pneumonia have been effective in reducing childhood mortality, but the last major revision was over 10 years ago. The emergence of antimicrobial resistance, new pneumonia pathogens, and new drugs have prompted WHO to assemble an international panel to review the literature on childhood pneumonia and to develop evidence-based recommendations for the empirical treatment of non-severe pneumonia among children managed by first-level health providers. Treatment should target the bacterial causes most likely to lead to severe disease, including Streptoccocus pneumoniae and Haemophilus influenzae. The best first-line agent is amoxicillin, given twice daily for 3-5 days, although co-trimoxazole may be an alternative in some settings. Treatment failure should be defined in a child who develops signs warranting immediate referral or who does not have a decrease in respiratory rate after 48-72 h of therapy. If failure occurs, and no indication for immediate referral exists, possible explanations for failure should be systematically determined, including non-adherence to therapy and alternative diagnoses. If failure of the first-line agent remains a possible explanation, suitable second-line agents include high-dose amoxicillin-clavulanic acid with or without an affordable macrolide for children over 3 years of age.
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