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Pulse oximetry and hospital observation can detect failure of amoxicillin treatment earlier in children with severe pneumonia

Unlike the situation in industrialized nations, childhood pneumonia in developing countries is usually caused by bacteria instead of viruses. A recent, hospital-based study found that oral amoxicillin was equal to injectable penicillin for treating children with severe pneumonia in developing countries. This finding supports the home administration of oral amoxicillin. However, a new study indicates that a 12- to 24-hour period of observation in the hospital, ideally with pulse oximetry to measure oxygen saturation, is needed to identify children whose oral amoxicillin treatment has failed and who will need additional treatment. For example, one-fifth of the children in the study needed supplemental oxygen at least once during the first 24 hours of observation, and two-fifths needed bronchodilator therapy.

However, the researchers note that the feasibility of providing observational stays and pulse oximetry for children at first-referral health facilities in developing nations has yet to be determined. They used data from a previously reported, multinational trial of orally administered amoxicillin versus injectable penicillin for the treatment of severe pneumonia in children 3 to 59 months of age. They developed models to assess the ability to predict amoxicillin treatment failure among the 857 children randomly assigned to the amoxicillin group. The models were based on signs, symptoms, and laboratory data at baseline, 12 hours, and 24 hours later.

Oral amoxicillin treatment failed in 18 percent of children. Based on the models, identification of children at high risk of amoxicillin treatment failure can be achieved with 12 hours of patient observation, if the capacity to measure blood oxygen saturation is available. If it is not, then information gathered after 24 hours of observation without pulse oximetry may be equally beneficial in predicting treatment failure. Oximetry data improved the predictive ability at the childŐs initial presentation to the hospital, 12 hours, and 24 hours. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00060).

See "Brief hospitalization and pulse oximetry for predicting amoxicillin treatment failure in children with severe pneumonia," by Linda Y. Fu, M.D., M.Sc., Robin Ruthazer, M.P.H., Ira Wilson, M.D., M.Sc., and others, in the December 2006 Pediatrics 118(6), pp. e1822-e1830.

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