title: Response to cotrimoxazole in the management of childhood pneumonia in first-level health care facilities.
abstract: BACKGROUND
  Reports of high levels of antimicrobial resistance to cotrimoxazole in children with non-severe pneumonia (NSP) have prompted calls for a change to amoxicillin in the therapeutic guidelines at the first-level health care facility (FLHF). FLHFs lack data about the use of World Health Organization (WHO) acute respiratory infection (ARI) standard case management (SCM).
  
  
  OBJECTIVE
  To apply ARI SCM guidelines at the FLHF, assess clinical outcome of NSP with oral cotrimoxazole and determine the risk factors influencing treatment outcome.
  
  
  METHODS
  Health care workers (HCWs) at 14 health centres managed children aged 2-59 months with NSP according to ARI SCM guidelines. The primary outcome was treatment failure, including change of antibiotic therapy and loss to follow-up.
  
  
  RESULTS
  Of 949 children enrolled, 110 (11.6%) failed therapy with oral cotrimoxazole. Clinical failure was significantly higher among children presenting with a fast respiratory rate of > or = 15 breaths/min above normal for age and wheezing on examination.
  
  
  CONCLUSIONS
  To treat children with NSP at the FLHF, oral cotrimoxazole is an acceptable treatment choice in view of the efficacy, cost and ease of use. In children with wheezing and signs of pneumonia, the decision to use antibiotic therapy should be made after a trial of bronchodilator therapy.
authors.affiliation: Department of Health, Aga Khan Foundation, Islamabad, Pakistan. qayyum.noorani@akfp.org
authors.forename: Q A
authors.initials: QA
authors.lastname: Noorani
authors.forename: S A
authors.initials: SA
authors.lastname: Qazi
authors.forename: Z A
authors.initials: ZA
authors.lastname: Rasmussen
authors.forename: G N
authors.initials: GN
authors.lastname: Rehman
authors.forename: S S
authors.initials: SS
authors.lastname: Khan
authors.forename: I
authors.initials: I
authors.lastname: Muhammadullah
authors.forename: Y K
authors.initials: YK
authors.lastname: Mohammad
authors.forename: G A
authors.initials: GA
authors.lastname: Sher
authors.forename: N H
authors.initials: NH
authors.lastname: Munir
mesh_terms: D000284:Administration, Oral; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019090:Case Management / Q000592:standards; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006268:Health Facilities / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D012119:Respiration / Q000187:drug effects; D012307:Risk Factors; D018401:Sample Size; D012720:Severity of Illness Index; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination