title: Recommendations for treatment of childhood non-severe pneumonia.
abstract: WHO recommendations for early antimicrobial treatment of childhood pneumonia have been effective in reducing childhood mortality, but the last major revision was over 10 years ago. The emergence of antimicrobial resistance, new pneumonia pathogens, and new drugs have prompted WHO to assemble an international panel to review the literature on childhood pneumonia and to develop evidence-based recommendations for the empirical treatment of non-severe pneumonia among children managed by first-level health providers. Treatment should target the bacterial causes most likely to lead to severe disease, including Streptoccocus pneumoniae and Haemophilus influenzae. The best first-line agent is amoxicillin, given twice daily for 3-5 days, although co-trimoxazole may be an alternative in some settings. Treatment failure should be defined in a child who develops signs warranting immediate referral or who does not have a decrease in respiratory rate after 48-72 h of therapy. If failure occurs, and no indication for immediate referral exists, possible explanations for failure should be systematically determined, including non-adherence to therapy and alternative diagnoses. If failure of the first-line agent remains a possible explanation, suitable second-line agents include high-dose amoxicillin-clavulanic acid with or without an affordable macrolide for children over 3 years of age.
authors.affiliation: National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. gbgrant@cdc.gov
authors.forename: Gavin B
authors.initials: GB
authors.lastname: Grant
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
authors.forename: Scott F
authors.initials: SF
authors.lastname: Dowell
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Graham
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: E Kim
authors.initials: EK
authors.lastname: Mulholland
authors.forename: Mark
authors.initials: M
authors.lastname: Steinhoff
authors.forename: Martin W
authors.initials: MW
authors.lastname: Weber
authors.forename: Shamim
authors.initials: S
authors.lastname: Qazi
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage*; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D006801:Humans; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D017211:Treatment Failure; D014944:World Health Organization; D018440:beta-Lactam Resistance / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin