Boston University School of Public Health Research Shows Pneumonia Treatment at Home is as Effective as In-hospital

in Health & Medicine, News Releases, School of Public Health
January 4th, 2008

Contact: Lisa Ann Brown, 617-414-1401 | brownl@bu.edu

(BOSTON) – A landmark study showing that children with severe pneumonia can be treated as effectively at home as they can be in hospitals could change the way the illness is managed in developing countries, saving lives and taking pressure off health systems.

The research, conducted in Pakistan by researchers from Center for International Health and Development at the Boston University School of Public Health (BUSPH) and supported by the World Health Organization (WHO) and USAID, is published in the January 4, 2008 edition of The Lancet medical journal. The study involved 2037 children with severe pneumonia randomly assigned to get either injectable antibiotics in a hospital or antibiotic syrup at home. The trial was the first to compare the outcomes of hospital treatment of severe pneumonia with treatment at home. The results demonstrate the safety and efficacy of treating pneumonia with oral antibiotics outside of a hospital setting.

An accompanying Lancet editorial called the study a “milestone,” adding that “the potential impact of these results on programmes is enormous, particularly in terms of our ability to treat a substantial proportion of children with severe pneumonia who are currently referred to a hospital but never reach there.”

According to the WHO, pneumonia is the largest single killer of children under five years old around the world. Almost four children die from pneumonia every minute. About 60 percent of pneumonia cases in the developing world are caused by bacteria and can be treated with antibiotics, whereas most cases of pneumonia in developed countries are viral.

The study found 87 (8.6%) treatment failures in the hospitalized group, and 77 (7.5%) in the group treated at home. Of the five children (0.2%) who died during the study, four were in the hospitalized group and one was at home.

“This study is especially important for the millions of poor children who because of distance, cost, or transportation barriers are unable to receive care in a hospital each year,” said Donald Thea, professor of international health at BUSPH, and corresponding author of the study. “Treating children at home with oral amoxicillin is as safe a treatment as standard intravenous therapy care delivered in-hospital. By treating children at home, we can also prevent exposing them to illnesses associated with hospitalization while simultaneously reducing the burden on overcrowded hospitals.”

This study confirmed the findings of three other trials at sites in Africa, Asia, Europe and Latin America, which showed that oral antibiotics were just as effective as injectable antibiotics in treating hospitalized children with severe pneumonia.

According to WHO, current guidelines advise health workers to provide oral antibiotics for cases of non-severe pneumonia and to refer severe and very severe cases to hospitals for treatment with antibiotics by injection. However, many children with severe pneumonia who are currently referred for admission to a hospital either die before they reach there or are so sick by the time they arrive that nothing more can be done to save them.

A small number of cases of very severe pneumonia (around 2-3% of all pneumonia cases) will still require treatment with injectable antibiotics in a hospital.

Families in the poorest countries, where the majority of children are affected by pneumonia, may not have easy access to hospitals. In-patient treatment may not be an option for parents who cannot leave their homes to accompany the sick child. In addition, children with severe pneumonia are vulnerable to infections as a result of weak immunity and could be at increased risk in crowded hospital wards. A community-based approach would bring treatment to people’s homes, so that children with pneumonia can be identified and begin treatment before the onset of life-threatening complications.

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