Treat Pneumonia With The Wonder Drugs

Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs. It is the prime cause of child mortality under 5 accounting for 20% post-neonatal deaths worldwide. The best way to reduce pneumonia related mortality is to provide timely and effective treatment.  When children suffering from pneumonia are promptly treated with antibiotics, popularly known as “wonder drugs” chances of mortality are considerably lowered. Estimates suggest that if antibiotic treatment were universally delivered to children with pneumonia, around 600,000 lives could be saved each year. This number could more than double to 1.3 million if both prevention and treatment interventions to reduce pneumonia deaths were universally delivered.

Chest X-rays and laboratory tests are used to confirm the disease in which pus and fluid fill the alveoli in one or both lungs, which interfere with oxygen absorption, making breathing difficult. But in resource-poor settings, suspected cases of pneumonia are diagnosed by their clinical symptoms like rapid or difficult breathing, cough, fever, and wheezing. Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions. Caregivers, therefore, have an important role to play in recognizing the symptoms of pneumonia in children and seeking appropriate medical care. Non-severe pneumonia can be treated with appropriate antibiotics. Severe pneumonia cases should be referred urgently to a hospital for injectible antibiotics and oxygen if needed. Three essential steps needed to reduce deaths among children under five with pneumonia are (i) recognize that a child is sick with pneumonia, (ii) seek appropriate care, at hospitals/health centres/maternal and child health clinics, and (iii) get recommended treatment. However, only an estimated 20% of the care givers in developing countries recognize the symptoms and only about 54% respond to them by taking the child to a health care provider. As compared to poor children, children from urban and educated families are more likely to be taken for appropriate medical care. Also, only about 33% of the children with suspected pneumonia in 68 high burden countries receive antibiotics.

Infants under two months with signs of pneumonia/sepsis are at greater risk of suffering severe illness and death more quickly than older children, and should be immediately referred to a hospital for treatment. Treatment regimens need to be chosen based on their efficacy in local settings. Some areas may have high levels of resistance to certain antibiotics, rendering those drugs less effective for treating pneumonia. Other areas may have large numbers of high-risk groups, such as undernourished or HIV-positive children, and may need to adapt their treatment strategies accordingly.

Dr. S. K. Sehta, Consultant Paediatrician and Neonatologist of Lucknow explains that, “The Government of India (GOI) and the World Health Organisation (WHO) have recommended steps for easy diagnosis of pneumonia so that even in the villages, where doctors are not available, a layman can diagnose this disease. Basically the WHO has categorized three types of pneumonia-- (i)No pneumonia (ii)Pneumonia- the treatment of which is Septron and (iii)Severe Pneumonia – In this case the GOI recommends that if the person is trained he/she should administer ampicillin- gentamycin to the patient and refer the patient to a specialist.”

Dr. S. N. Rastogi, Paediatrician and Child Cardiologist of Lucknow says, “Treatment depends on the causative agents which could be bacteria or even non bacteria. Thus the treatment differs. In India the most common pneumonia is tubercular pneumonia. For treating pneumonia we can give streptomycin.”
Dr. S. K. Sehta, who has worked for a number of years in renowned public as well as private hospitals of Lucknow and Delhi, says, “The WHO recommendations are being followed in government hospitals. GOI and the WHO focus on the concerns of the masses. Hence Septron is a very good and cheap treatment for pneumonia and is recommended by GOI in the rural areas. However in the private sector individual concern is more important for us and we are observing high resistance to Septron. So we choose to give stronger antibiotics.”

According to Dr. Neelam Singh, Consultant Obstetrician and Gynaecologist and Chief Functionary of Vatsalya Resource Centre on Health, acute respiratory tract infections treatment in children is a part of the Comprehensive Child Survival programme in many States. However, the kind of awareness drive that is needed for pneumonia prevention is lacking. There is still a lot of ignorance and a special drive needs to be conducted to spread awareness. Pneumonia is a major life threatening disease of children after diarrhoea. Time, advice, treatment, cost of treatment and other factors are responsible for the disparity between the treatments administered in the government and private hospitals. The government has made great progress in this field and now these treatments are available in government hospitals too. However, the pressure of large number of patients, shortage of experts, lack of infrastructure, and non availability of medicines are some of the concerns in the public health system that need attention.

A quintessential example of how improper management of pneumonia in children can lead to severe complications comes from the story of Atharva, a 3 years old child who was recuperating in the paediatric wing of the Chattrapati Sahuji Maharaj Medical University (CSMMU and erstwhile King George’s Medical College) when I met him in the first week of October, 2011.  His parents had sought prompt medical treatment in the private sector at the first sign of pneumonia. But they ran from one nursing home to another, while the condition of Atharva deteriorated. They felt that the doctors were interested only in extracting money from them, before finally giving up on the child. As a last resort, they took him to CSMMU, a government hospital, on the 4th of August. He finally responded to some latest antibiotic available in the market and his condition stabilised. This is a classic example of how we in India, tend to generally undermine the government health system, which, despite its inherent drawbacks, is capable of providing the best of care to critically ill patients.

The Global Action Plan for the prevention and control of pneumonia (GAPP) launched in 2009, aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children. Let us all join hands to ensure that every sick child has access to the right kind of care and treatment for pneumonia.

Somya Arora - CNS
(The author is doing her post-graduation in microbiology from Lucknow University and writes on social justice issues for CNS: