The management of pneumonia in children in developing countries

Pneumonia kills about 3 million children every year in developing countries, and it is now clear that most fatal pneumonia is caused by Haemophilus influenzae or Streptococcus pneumoniae. To reduce mortality associated with pneumonia, the World Health Organization has developed guidelines for the treatment of children in developing countries who have cough or difficulty breathing: children without tachypnea or chest indrawing do not need antibiotic therapy; children with tachypnea but no chest indrawing should have antibiotic therapy at home; and children with chest indrawing should be admitted to the hospital for intramuscular injections of benzylpenicillin or chloramphenicol. Universal application of these guidelines would save the lives of approximately 600,000 children every year. Other important issues are oxygen therapy, fluid restriction, limitation of the use of acetaminophen, pneumonia in neonates, and the emergence of antibiotic resistance. There is an urgent need for vaccines that protect infants against infection with S. pneumoniae and all strains of H. influenzae, including nonserotypeable strains.