Antibiotic Therapy: The Pneumonia Panacea

Pneumonia is the single largest cause of death in children worldwide. It kills an estimated 1.6 million children every year – more than AIDS, malaria and tuberculosis combined. Almost four children die from pneumonia every single minute. Research has shown that prevention and proper treatment of pneumonia could avert one million deaths in children every year. With proper treatment alone, 600 000 deaths could be avoided. The World Health Organization (WHO) and UNICEF launched Integrated Management of Neonatal and Childhood Illness (IMNCI) and which aims to protect, prevent, and treat pneumonia in children. There have been few studies of the clinical efficacy for identifying and treating pneumonia in children in developing countries with low-cost, low-tech medication and care.

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which are filled with air. When an individual has pneumonia, the alveoli get filled with pus and fluid, which makes breathing painful and limits oxygen intake. The common symptoms of pneumonia are rapid or difficult breathing, cough, fever, chills, loss of appetite and wheezing in case of very severe pneumonia. When it becomes critical, children may experience in-drawing of chest, hypothermia and convulsions.

Pneumonia can be treated with antibiotics, but less than 20% of children with pneumonia receive the antibiotics they need. Although the WHO guidelines advise health workers to provide oral antibiotics for cases of non-severe pneumonia and to refer severe cases to hospitals for treatment with antibiotics by injection, many children with severe pneumonia either die before they reach a hospital, or are so sick by the time they arrive that nothing more can be done to save them. Hence, WHO, and UNICEF have initiated a Global Action Plan for Prevention and Control of Pneumonia (GAPP) in the context of child survival strategy which identifies priority activities that need to be conducted to reduce pneumonia mortality.

About 60% of pneumonia cases in the developing world are caused mainly by bacteria. Antibiotics to a large extend can control pneumonia if provided well on time. Dr.Y.C.Govil (Professor of Pediatrics in Chatrapati Sahuji Maharaj Medical University) says," Penicillin was discovered in the 1930s, and before that there were no antibiotics and people use to die like flies. Similar thing will happen if pneumonia is not checked. It is unfortunate, but now a days, a lot of antibiotic misuse is happening in our country and the reason is that many a times patients are been treated by unqualified practitioners of medicine in rural areas. I think almost 20%-30% or even more of patients would initially go to an unqualified practitioner. So here they are in the habit of advising lots of broad spectrum antibiotics in the beginning. Even in viral infection, where antibiotics are not usually indicated, antibiotics are prescribed. This is also prevalent in the urban setup as well. Very often patients try to self medicate also, as antibiotics are easily available over the counter. This develops a resistance against normal (narrow spectrum) antibiotics, thus making them ineffective." 

Very severe pneumonia in children under five requires treatment with injectible antibiotics in a hospital. The case management strategy for very severe pneumonia, which includes treatment with injectible chloramphenicol followed by oral chloramphenicol, has successfully decreased child deaths from pneumonia. WHO recommends the treatment at the level of  primary health workers, and for them the guidelines are just to recognize it by increased respiratory rate  and administer some basic antibiotics and if required then refer the child to a hospital.

Dr. Vijaya Mohan (Consultant Pediatrician, Vivekananda Polyclinic and Institute of Medical Sciences) says," We can diagnose pneumonia by physical and clinical findings and also by examining blood or X-ray. Even if the facilities are not available then by simply examining the child one can detect pneumonia. Antibiotics administered in the treatment of pneumonia, actually depend on the organism which is causing pneumonia. Penicillins, cephalosporins are usually suggested. But in the field WHO recommends Cotrimoxazole, Chloramphenicol."

Shikha Srivastava - CNS