Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study
Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study
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DOI：
10.1111/j.1365-3156.2011.02787.x
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发表时间：
2011-08-01
影响因子：
3.3
通讯作者：
Qazi, Shamim
中科院分区：
文献类型：
--
作者：
Addo-Yobo, Emmanuel;Anh, Dang D.;Qazi, Shamim
目的最近的一项随机临床试验表明，口服阿莫西林治疗WHO定义的重症肺炎的家庭治疗与医院治疗和肠外抗生素治疗相当。我们的目的是确定这一发现是否是generalizable在四个countries.METHODS多中心观察性研究在孟加拉国，埃及，加纳和越南之间的2005年11月和2008年5月。患有世卫组织定义的重症肺炎的3-59个月儿童在参与的卫生中心登记，并在家中口服阿莫西林（每天80-90 mg/kg）5天。在第1、2、3、6天对儿童进行随访，第14天在一家机构进行随访，观察到第6天的累积治疗失败和第6 ~ 14天的复发情况。结果在6582名筛查儿童中，873名被纳入，其中823名有明确的结局。有很大的差异，提出的特点，网站。孟加拉国和加纳的发热（97%）是比埃及（74%）和越南（66%）更常见的症状，而在越南，可听到的喘息（49%）比其他地区（范围2-16%）更常见。所有研究中心第6天的治疗失败率为9.2%（95% CI：7.3-11.2%），从加纳的6.4%（95% CI：3.1-9.8%）到越南的13.2%（95% CI：8.4-18.0%）不等; 733例第6天良好的儿童中有2.7%（95% CI：1.5-3.9%）在第14天复发。治疗失败的最常见原因是第6天持续的下胸壁内陷（LCI）（3.8%; 95% CI：2.6-5.2%）、异常嗜睡或难以醒来（1.3%; 95% CI：0.7-2.3%）和中心性紫绀（1.3%; 95% CI：0.7-2.3%）。所有儿童均存活，仅发生1例药物不良反应。治疗失败是更常见的年轻婴儿和那些呈现快速呼吸rates.CONCLUSIONS临床治疗失败和严重肺炎的儿童在家中口服阿莫西林治疗的不良事件发生率并没有显着不同的地理区域。因此，重症肺炎的家庭治疗可以应用于各种各样的环境。
OBJECTIVE A recent randomized clinical trial demonstrated home-based treatment of WHO-defined severe pneumonia with oral amoxicillin was equivalent to hospital-based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries.METHODS Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3-59 months with WHO-defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80-90 mg/kg per day) for 5 days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14.RESULTS Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2-16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3-11.2%) across all sites, varying from 6.4% (95% CI: 3.1-9.8%) in Ghana to 13.2% (95% CI: 8.4-18.0%) in Vietnam; 2.7% (95% CI: 1.5-3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6-5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7-2.3%) and central cyanosis (1.3%; 95% CI: 0.7-2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates.CONCLUSIONS Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home-based therapy of severe pneumonia can be applied to a wide variety of settings.