title: Brief hospitalization and pulse oximetry for predicting amoxicillin treatment failure in children with severe pneumonia.
abstract: OBJECTIVE
  In settings with limited assessment tools, we sought to determine whether early clinical signs and symptoms and blood oxygen saturation would predict amoxicillin treatment failure in children with severe pneumonia (as defined by the World Health Organization).
  
  
  METHODS
  Data were from a previously reported, multinational trial of orally administered amoxicillin versus injectable penicillin for the treatment of World Health Organization-defined severe pneumonia in children 3 to 59 months of age. We assessed all 857 participants assigned randomly to the experimental amoxicillin arm. Six multivariate logistic regression models were created and evaluated for their ability to predict failure after 48 hours of therapy. Regression models included vital signs, symptoms, and laboratory data collected at baseline and after 12 or 24 hours of observation. Oxygen saturation data were included in 3 models.
  
  
  RESULTS
  Clinical treatment failure occurred for 18% of children. Younger age, increased initial respiratory rate, and baseline hypoxia predicted treatment failure in all models. Data available after 24 hours improved the ability to predict failure compared with data available at baseline or 12 hours. The inclusion of oximetry data improved the predictive ability at baseline, 12 hours, and 24 hours. The ability to predict failure after 12 hours of observation with oximetry data was similar to the predictive ability after 24 hours without pulse oximetry data.
  
  
  CONCLUSIONS
  Assessment of clinical parameters at presentation and after 24 hours improved the ability to predict clinical failure of oral amoxicillin therapy, compared with assessment at presentation alone or at presentation and after only 12 hours, for children with World Health Organization-defined severe pneumonia.
authors.affiliation: Department of General and Community Pediatrics, George Washington University, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010, USA. lfu@cnmc.org
authors.forename: Linda Y
authors.initials: LY
authors.lastname: Fu
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Ira
authors.initials: I
authors.lastname: Wilson
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: LeAnne M
authors.initials: LM
authors.lastname: Fox
authors.forename: Tran Anh
authors.initials: TA
authors.lastname: Tuan
authors.forename: Prakash
authors.initials: P
authors.lastname: Jeena
authors.forename: Noel
authors.initials: N
authors.lastname: Chisaka
authors.forename: Mumtaz
authors.initials: M
authors.lastname: Hassan
authors.forename: Juan
authors.initials: J
authors.lastname: Lozano
authors.forename: I
authors.initials: I
authors.lastname: Maulen-Radovan
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Shamim
authors.initials: S
authors.lastname: Qazi
authors.forename: Patricia
authors.initials: P
authors.lastname: Hibberd
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D010092:Oximetry; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin