Failure of standard antimicrobial therapy in children aged 3-5 months with mild or asymptomatic HIV infection and sever pneumonia

Jeena, Prakash; Thea, Donald M.; MacLeod, W. Bentley; Chisaka, Noel; Fox, Matthew P.; Coovadia, Hoosen M.; Qazi, Shamim

doi:10.2471/blt.04.015222

Cited by 21 publications

(5 citation statements)

References 16 publications

(25 reference statements)

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“…This finding is similar to the previous study done in 2013 in Nagpur, India in which 4.9% died due to treatment failure [16]. However, our finding is high compared to the studies done in South Africa 2006, in which 2.2% died while on second line antibiotics treatment [24]. On the other hand, this finding is low compared to the studies done in India and Kenya 2009 and 2013 with mortality ranged from 10.2%-16% respectively [9,10].…”

Section: Outcome After First Line Antibiotics Treatment Failuresupporting

confidence: 89%

Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study

et al. 2020

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Background Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP. Results A total of 250 children with SCAP with a median age of 18 [IQR 9–36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11–2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16–2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01–1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28–2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42–2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04–2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56–2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%. Conclusion Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality.

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Section: Outcome After First Line Antibiotics Treatment Failuresupporting

confidence: 89%

Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study

et al. 2020

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“…7 Additionally, HIV-infected children not receiving antiretroviral treatment have poor response to empirical treatment targeted predominantly against Haemophilus influenzae type b and Streptococcus pneumoniae and need broad-spectrum antibiotics to cover a range of microbial infections. 8 As many as 55% of HIV-infected African children die within the first 2 years of life in the absence of antiretroviral treatment, 9,10 with pneumonia reported to be the main cause of hospital admissions and deaths in these children. 11–13 Severe pneumonia associated with opportunistic infections including Pneumocystis jirovecii pneumonia and cytomegalovirus is common in HIV-infected children.…”

Section: Introductionmentioning

confidence: 99%

Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study

Τheodoratou

McAllister

Reed

et al. 2014

The Lancet Infectious Diseases

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SummaryBackgroundGlobally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010.MethodsWe estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010.FindingsThe odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9–7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7–12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400–153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million–2·7 million) and 85 400 deaths (UR 46 000–147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region.InterpretationGlobally, a small proportion of pneumonia episodes and pneumonia deaths occur in HIV-infected children. However, in the highest HIV-burden countries in sub-Saharan Africa (ie, Swaziland, Lesotho, and Zimbabwe) up to a fifth of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children. In these countries, major reductions in child pneumonia mortality can be achieved only if the systemic challenges plaguing the health system (poor coverage of early infant testing for HIV, of antiretroviral drugs in pregnant women and young children, of co-trimoxazole prophylaxis, and of pneumococcal vaccination) can be overcome.FundingWHO.

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“…Three found oral amoxicillin vs injectable penicillin or ampicillin to have equal efficacy for children 3-59 months of age [ 26 , 27 , 29 ]. In a sub-analysis of a trial conducted by Addo Yobo et al, Jeena et al [ 28 ] found greater treatment failure with oral amoxicillin or parenteral penicillin at day 2 and day 14 among children with human immunodeficiency virus (HIV) compared with children without HIV.…”

Section: Resultsmentioning

confidence: 99%

Emergency care interventions for paediatric severe acute respiratory infections in low- and middle-income countries: A systematic review and narrative synthesis

et al. 2023

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Background Severe acute respiratory infections (SARIs) are the leading cause of paediatric death globally, particularly in low- and middle-income countries (LMICs). Given the potential rapid clinical decompensation and high mortality rate from SARIs, interventions that facilitate the early care are critical to improving patient outcomes. Through this systematic review, we aimed to evaluate the impact of emergency care interventions on improving clinical outcomes of paediatric patients with SARIs in LMICs. Methods We searched PubMed, Global Health, and Global Index Medicus for peer-reviewed clinical trials or studies with comparator groups published before November 2020. We included all studies which evaluated acute and emergency care interventions on clinical outcomes for children (29 days to 19 years) with SARIs conducted in LMICs. Due to observed heterogeneity of interventions and outcomes, we performed narrative synthesis. We assessed bias using the Risk of Bias 2 and Risk of Bias in Non-Randomized Studies of Interventions tools. Results We screened 20 583, 99 of which met the inclusion criteria. Conditions studied included pneumonia or acute lower respiratory infection (61.6%) and bronchiolitis (29.3%). Studies evaluated medications (80.8%), respiratory support (14.1%), and supportive care (5%). We found the strongest evidence of benefit for decreasing risk of death for respiratory support interventions. Results were inconclusive on the utility of continuous positive airway pressure (CPAP). We found mixed results for interventions for bronchiolitis, but a possible benefit for hypertonic nebulised saline to decrease hospital length of stay. Early use of adjuvant treatments such as Vitamin A, D, and zinc for pneumonia and bronchiolitis did not appear to have convincing evidence of benefit on clinical outcomes. Conclusions Despite the high global burden of SARI in paediatric populations, few emergency care (EC) interventions have high quality evidence for benefit on clinical outcomes in LMICs. Respiratory support interventions have the strongest evidence for benefit. Further research on the use of CPAP in diverse settings is needed, as is a stronger evidence base for EC interventions for children with SARI, including metrics on the timing of interventions. Registration PROSPERO (CRD42020216117)

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Failure of standard antimicrobial therapy in children aged 3-5 months with mild or asymptomatic HIV infection and sever pneumonia

Cited by 21 publications

References 16 publications

Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study

Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study

Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study

Emergency care interventions for paediatric severe acute respiratory infections in low- and middle-income countries: A systematic review and narrative synthesis

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