TitleLow Rates of Treatment Failure in Children 2-59 Months Treated for Severe Pneumonia: A Multi-site Pooled Analysis
AuthorsMatthew P. Fox, Donald M. Thea, Salim Sadruddin, Abdul Bari, Rachael Bonawitz, Tabish Hazir, Yasir Bin Nisar, and Shamim A. Qazi ; for the Pneumonia Studies Group
PublicationClinical Infectious Diseases. 2013 Jan; 56(7):978-987.


Despite advances in childhood pneumonia management, it remains a major killer of childrenworldwide. We sought to estimate global treatment failure rates in children aged 2–59 months with World HealthOrganization–defined severe pneumonia.


We pooled data from 4 severe pneumonia studies conducted during 1999–2009 using similar methodologies. We defined treatment failure by day 6 as death, danger signs (inability to drink, convulsions, abnormally sleepy), fever (≥38°C) and lower chest indrawing (LCI; days 2–3), LCI (day 6), or antibiotic change.


Among 6398 cases of severe pneumonia from 10 countries, 564 (cluster adjusted: 8.5%; 95% confi-dence interval [CI], 5.9%–11.5%) failed treatment by day 6. The most common reasons for clinical failure werepersistence of fever and LCI or LCI or fever alone (75% of failures). Seventeen (0.3%) children died. Danger signswere uncommon (<1%). Infants 6–11 months and 2–5 months were 2- and 3.5-fold more likely, respectively, tofail treatment (adjusted OR [AOR], 1.8 [95% CI, 1.4–2.3] and AOR, 3.5 [95% CI, 2.8–4.3]) as children aged 12–59months. Failure was increased 7-fold (AOR, 7.2 [95% CI, 5.0–10.5]) when comparing infants 2–5 months withvery fast breathing to children 12–59 months with normal breathing.


Our findings demonstrate that severe pneumonia case management with antibiotics at healthfacilities or in the community is associated with few serious morbidities or deaths across diverse geographic settings and support moves to shift management of severe pneumonia with oral antibiotics to outpatients in thecommunity