title: Low rates of treatment failure in children aged 2-59 months treated for severe pneumonia: a multisite pooled analysis.
abstract: BACKGROUND
  Despite advances in childhood pneumonia management, it remains a major killer of children worldwide. We sought to estimate global treatment failure rates in children aged 2-59 months with World Health Organization-defined severe pneumonia.
  
  
  METHODS
  We pooled data from 4 severe pneumonia studies conducted during 1999-2009 using similar methodologies. We defined treatment failure by day 6 as death, danger signs (inability to drink, convulsions, abnormally sleepy), fever (≥38°C) and lower chest indrawing (LCI; days 2-3), LCI (day 6), or antibiotic change.
  
  
  RESULTS
  Among 6398 cases of severe pneumonia from 10 countries, 564 (cluster adjusted: 8.5%; 95% confidence interval [CI], 5.9%-11.5%) failed treatment by day 6. The most common reasons for clinical failure were persistence of fever and LCI or LCI or fever alone (75% of failures). Seventeen (0.3%) children died. Danger signs were uncommon (<1%). Infants 6-11 months and 2-5 months were 2- and 3.5-fold more likely, respectively, to fail treatment (adjusted OR [AOR], 1.8 [95% CI, 1.4-2.3] and AOR, 3.5 [95% CI, 2.8-4.3]) as children aged 12-59 months. Failure was increased 7-fold (AOR, 7.2 [95% CI, 5.0-10.5]) when comparing infants 2-5 months with very fast breathing to children 12-59 months with normal breathing.
  
  
  CONCLUSIONS
  Our findings demonstrate that severe pneumonia case management with antibiotics at health facilities or in the community is associated with few serious morbidities or deaths across diverse geographic settings and support moves to shift management of severe pneumonia with oral antibiotics to outpatients in the community.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, USA. mfox@bu.edu
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Salim
authors.initials: S
authors.lastname: Sadruddin
authors.forename: Abdul
authors.initials: A
authors.lastname: Bari
authors.forename: Rachael
authors.initials: R
authors.lastname: Bonawitz
authors.forename: Tabish
authors.initials: T
authors.lastname: Hazir
authors.forename: Yasir
authors.initials: Y
authors.lastname: Bin Nisar
authors.forename: Shamim A
authors.initials: SA
authors.lastname: Qazi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents