Children With Severe Pneumonia Can Be Treated at Home, Doctors Say

Children with severe pneumonia can be treated just as effectively at home as in a hospital, according to new research.

Doctors in Pakistan found that children taking antibiotics at home were as likely to survive serious pneumonia as those treated in hospitals. The study was published Friday in the British medical journal, The Lancet.

"If this (home) treatment was implemented on a wide scale, then we could potentially save millions of children," said Dr. Renee Van de Weerdt, a child health expert at UNICEF, who was not involved in the study.

"This shows us that we can do something about pneumonia at the community level," Van de Weerdt said. "It doesn't always require a sophisticated hospital."

Pneumonia is the top killer of children under five worldwide, causing one-fifth of the 10 million deaths every year.

Pneumonia is an inflammation of the lungs that causes coughing, breathing difficulties, fever and muscle pain. About five to 10 percent of all children under five in developing countries get pneumonia every year. Children with HIV or malaria are at particular risk.

Under current World Health Organization guidelines, health workers refer children with severe pneumonia to hospitals to receive antibiotics through injections. But in many poor countries, children referred to hospitals often don't receive care if their parents cannot afford it or if there is no nearby hospital.

In the Lancet study, doctors in Pakistan randomly assigned children with serious pneumonia to either receive antibiotic shots in the hospital for two days, or to take antibiotics at home for five days. Parents of the children sent home were instructed how and when to give their children the antibiotics.

The research was conducted at seven sites across Pakistan: 1,012 children were hospitalized and 1,025 were treated at home. The children were aged between about three months and five years old.

Among the hospitalized children, 87 children did not respond to the treatment or developed complications. That compared to 77 children in those treated at home. Five children died during the study; four were in the hospitalized group and one was at home.

The study was conducted by researchers at Boston University's School of Public Health and colleagues, and was paid for by WHO and the U.S. Agency for International Development.

Treating children with severe pneumonia at home would also save health systems thousands of dollars. A course of medicines to be taken at home costs US$2 (euro1.36) at most.

Based on the Pakistani results and those of previous studies, WHO said it would soon revise its guidelines for children with pneumonia.

UNICEF said that trained community health workers, rather than parents, should be the ones giving drugs to children at home with severe pneumonia. "At the implementation level, there are quality control challenges," Van de Weert said. "We don't want antibiotics to be used wildly by anyone."

WHO said that not all children with severe pneumonia could be treated at home, and that a small percentage would still require hospitalization.

"Pneumonia is the single biggest killer of children in the world," said Dr. Shamim Qazi, a pediatrician at WHO. "We are hopeful that with the results from this study, we may be able to change that."