A new study by researchers
at Aga Khan University has highlighted the need to improve ways to
diagnose and treat pneumonia, a leading cause of death in children under
five around the world.
The Pakistan-based study, RETAPP, is the world’s largest
community-based assessment of the use or withholding of antibiotics in
children with mild pneumonia.
Pneumonia is a lung disease caused by viral or bacterial
infections. It is especially common in low and middle income countries
like Pakistan where malnutrition is prevalent and vaccine coverage is
low.
There are currently different views on the use of
antibiotics for treating the diseases. While global guidelines recommend
the use of antibiotics, two leading infectious diseases societies in
North America – the Pediatric Infectious Diseases Society and the
American Society of Tropical Medicine & Hygiene – advise against the
use of antibiotics in young children with mild pneumonia.
The Pakistan-based trial followed over 4,000 children and
found that antibiotics needed to be given to 44 children diagnosed with
mild pneumonia, under global guidelines, in order to prevent a single
child from deteriorating. This raises the risk of antibiotic resistance
among children who are not suffering from pneumonia.
Researchers noted that one of the primary symptoms to
diagnose mild pneumonia in children – fast breathing – is not specific to
pneumonia and can be seen with other illnesses such as fever and
dehydration. This often leads to misdiagnosis or misclassification of the
illness leading to antibiotics being used in too many cases.
“Resistance to commonly used antibiotics is a growing
concern among infectious disease specialists and other physicians,” says
Dr Fyezah Jehan, the study’s lead investigator and a specialist in
paediatric infectious diseases at AKU. “Our findings lend weight to
global efforts to reduce the unnecessary use of antibiotics by
highlighting that we are yet to understand the symptoms of pneumonia.”
Researchers also stressed the need to reconsider prevailing
thresholds of breaths per minute required to qualify for a pneumonia
diagnosis, in order to better identify children who need antibiotics.
They added that other factors such as fever and wheezing can also help
recognise children at risk of worsening symptoms of pneumonia.
The study by researchers at AKU, Uppsala University and the
Bill and Melinda Gates Foundation has been published in the New England
Journal of Medicine, NEJM, the most highly cited medical journal in the
world.
Other health researchers writing in an associated commentary
in the NJEM said: “These important trials conducted by Jehan et al. and
Ginsburg et al. have contributed to our current knowledge, yet many gaps
remain in our understanding of the appropriate management of pneumonia
and deserve greater attention.”
The study’s objectives are aligned with targets under
Sustainable Development Goal 3 that call for efforts to reduce
preventable deaths in children under the age of 5 from infectious
diseases such as pneumonia.
An international data safety and monitoring board oversaw
the study. Rigorous safety procedures were put in place throughout the
trial to protect children from harm.
Co-authors on the paper include Dr Imran Nisar, Ms Salima
Kerai, Dr Benazir Balouch, Mr Najeeb Rahman, Mr Nick Brown, Ms Arjumand
Rizvi, Mr Yasir Shafiq and Dr Anita Zaidi.
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