Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2-59 months in low resource settings: multicentre randomised controlled trial (SPEAR study)

Asghar, Rai Muhammad; Banajeh, Salem; Egas, Josefina; Hibberd, Patricia L.; Iqbal, Imran; Katep-Bwalya, Mary; Kundi, Zafarullah; Law, Paul A.; Macleod, W. Bentley; Maulén-Radován, Irene; Miño, G; Saha, Samir K.; Sempértegui, Fernando; Simon, Jonathon; Santosham, Mathuram; Singhi, Sunit; Thea, Donald M.; Qazi, Shamim

doi:10.1136/bmj.39421.435949.be

Cited by 84 publications

(69 citation statements)

References 36 publications

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“…16 In brief, inclusion criteria were age 2 to 59 months and WHO-defined severe pneumonia 15 (reclassified from the previous WHO definition of "very severe pneumonia," defined as cough or difficulty breathing plus $1 of the following: [1] Treatment failure at 10 to 12 days and 21 to 30 days was defined as the above plus relapse (hypoxemic pneumonia). Anemia was defined according to the WHO standards for children under 5 years of age as hemoglobin #11 g/dL.…”

Section: Methodsmentioning

confidence: 99%

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Childhood Anemia at High Altitude: Risk Factors for Poor Outcomes in Severe Pneumonia

2013

PEDIATRICS

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Section: Methodsmentioning

confidence: 99%

“…Therefore, we evaluated the effect of altitude and anemia on poor outcomes in young children with World Health Organization (WHO)-defined severe pneumonia 15 by using data from the previously completed Severe Pneumonia Evaluation Antimicrobial Research (SPEAR) study. 16 …”

mentioning

confidence: 99%

Childhood Anemia at High Altitude: Risk Factors for Poor Outcomes in Severe Pneumonia

2013

PEDIATRICS

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“…In this study, the bacterial isolates obtained from blood and lung aspirates in 110 children aged 2-59 months, Staph. aureus (n = 47) was the most common organism isolated (18). Blood cultures of the very severe pneumonia cohort (n = 151) in the Al-Sabeen site of the SPEAR study, showed that 28 (19%) were positive for bacterial growth.…”

Section: Pneumonia Evaluation Antimicrobialmentioning

confidence: 97%

Childhood very severe pneumonia and meningitis related hospitalization and death in Yemen, before and after introduction of H. influenzae type b [Hib] vaccine

Sm¹,

Ashoor²,

As³

2014

East Mediterr Health J

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Haemophilus influenzae type b (Hib) vaccine was included in the Yemen immunization programme in 2005. This study compared the rates of very severe pneumonia and all-cause meningitis hospitalization and death, before and after introduction of conjugate Hib vaccine, and reports the results of the 2010 bacterial meningitis surveillance. A retrospective analysis was made of data collected for 2000-2010 for all children aged 2-60 months in the main children's hospital in Sana'a. Compared with the pre-Hib vaccination period, the post-Hib period showed significant and impressive reductions in the rates of hospitalization and death for all-cause meningitis. However, hospitalization and death for very severe pneumonia improved only modestly, and there was evidence of a decreasing but non-significant trend indicting that very severe pneumonia was a non-specific endpoint with multi-etiologies (both viral and bacterial). Very severe pneumonia remains the leading cause of severe morbidity and death for young children, particularly those aged < 12 months.

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“…There was a higher treatment failure rate in the chloramphenicol group at 5 days (16% versus 11%; relative risk 1.43; 95% CI 1.03-1.97), at 10 days (19% versus 14%; relative risk 1.37; 95% CI 1.03-1.83) and 21 days (22% versus 16%; relative risk 1.34; 95%CI 1.02-1.75). Bacteremia was associated with a higher treatment failure rate in the chloramphenicol group [124]. Consequently hospitalised children with severe pneumonia should initially be treated with a B-lactam antibiotic and gentamicin.…”

Section: Management Of Pneumonia At Health Facilitymentioning

confidence: 99%

“…Until recently WHO guidelines recommended a combination of benzyl penicillin and gentamicin or chloramphenicol [122,123]. However, a recently published randomized controlled trial conducted in seven middle and low income countries in Asia, Africa and South America compared the clinical efficacy of intravenous ampicillin (50mg/kg four times a day) and gentamicin (7.5 mg/kg once a day) with chloramphenicol (25mg/kg three times a day) [124]. There was a higher treatment failure rate in the chloramphenicol group at 5 days (16% versus 11%; relative risk 1.43; 95% CI 1.03-1.97), at 10 days (19% versus 14%; relative risk 1.37; 95% CI 1.03-1.83) and 21 days (22% versus 16%; relative risk 1.34; 95%CI 1.02-1.75).…”

Section: Management Of Pneumonia At Health Facilitymentioning

confidence: 99%

Childhood Pneumonia in Low and Middle Income Countries: Burden, Prevention and Management

Gray¹,

Zar²

2010

TOIDJ

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Abstract:Background: Pneumonia is the leading cause of morbidity and mortality in children under five years of age worldwide. The burden of childhood pneumonia occurs predominantly in low or middle income countries. Despite recent advances in management and preventative strategies, high rates of treatment failure and case fatality continue to occur in children in such countries.Aim: To review the current evidence on the epidemiology and management of childhood pneumonia in low and middle income countriesMethods: Direct search of Medline database from 1995 to date through Pubmed was conducted. Search terms included: (pneumonia OR lower respiratory tract infections OR lower respiratory infections OR ARI) AND child. Search was restricted to English articles. In addition reference lists of selected studies were reviewed for relevant information.Findings: Major findings accounting for the high burden include delayed health seeking, poor access to health care, poorly resourced health care systems, inadequate immunisation programs and lack of availability of oxygen delivery systems. The burden of pneumonia deaths has also been increased by the paediatric HIV epidemic in sub-Saharan Africa. Effective preventive interventions include exclusive breastfeeding, optimizing nutrition, reduction of indoor air pollution and immunisations. Wider availability of new immunisations particularly pneumococcal conjugate vaccine can substantially reduce pneumonia incidence. Prophylactic trimethoprim-sulphamethoxazole and antiretroviral therapy are important strategies to prevent pneumonia in HIV infected children, and wider implementation of these is still needed. The most effective treatment strategy remains case management guidelines as contained in the Integrated Management of Childhood Illness program. Case management efficacy is dependent on timely access to health facilities, on health worker ability to recognise and treat pneumonia or severe pneumonia and on availability of appropriate antibiotics and functioning referral pathways. In areas of high HIV prevalence, guidelines must be adapted to broaden antimicrobial coverage including treatment for Pneumocystis jirovecii pneumonia. Monitoring of hypoxia with pulse oximetry and appropriate oxygen delivery systems are still not widely available and should be prioritized in pneumonia management programs.Conclusions: Improved access to preventive and management strategies is urgently needed to reduce the burden of childhood pneumonia in resource limited settings. Further research on childhood pneumonia is needed to delineate the burden of specific pathogens, to develop better diagnostic tests and to improve current management and preventive strategies.

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Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2-59 months in low resource settings: multicentre randomised controlled trial (SPEAR study)

Cited by 84 publications

References 36 publications

Childhood Anemia at High Altitude: Risk Factors for Poor Outcomes in Severe Pneumonia

Childhood Anemia at High Altitude: Risk Factors for Poor Outcomes in Severe Pneumonia

Childhood very severe pneumonia and meningitis related hospitalization and death in Yemen, before and after introduction of H. influenzae type b [Hib] vaccine

Childhood Pneumonia in Low and Middle Income Countries: Burden, Prevention and Management

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