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Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study

BACKGROUND: Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the pred...

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Autores principales: Muro, Restituta Phabian, Masoza, Tulla Sylvester, Kasanga, Godfrey, Kayange, Neema, Kidenya, Benson R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732094/
https://www.ncbi.nlm.nih.gov/pubmed/33306722
http://dx.doi.org/10.1371/journal.pone.0243636
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author Muro, Restituta Phabian
Masoza, Tulla Sylvester
Kasanga, Godfrey
Kayange, Neema
Kidenya, Benson R.
author_facet Muro, Restituta Phabian
Masoza, Tulla Sylvester
Kasanga, Godfrey
Kayange, Neema
Kidenya, Benson R.
author_sort Muro, Restituta Phabian
collection PubMed
description BACKGROUND: Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania. METHODS: The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP. RESULTS: A total of 250 children with SCAP with a median age of 18 [IQR 9–36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11–2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16–2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01–1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28–2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42–2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04–2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56–2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%. CONCLUSION: Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality.
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spelling pubmed-77320942020-12-17 Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study Muro, Restituta Phabian Masoza, Tulla Sylvester Kasanga, Godfrey Kayange, Neema Kidenya, Benson R. PLoS One Research Article BACKGROUND: Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania. METHODS: The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP. RESULTS: A total of 250 children with SCAP with a median age of 18 [IQR 9–36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11–2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16–2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01–1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28–2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42–2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04–2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56–2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%. CONCLUSION: Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality. Public Library of Science 2020-12-11 /pmc/articles/PMC7732094/ /pubmed/33306722 http://dx.doi.org/10.1371/journal.pone.0243636 Text en © 2020 Muro et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Muro, Restituta Phabian
Masoza, Tulla Sylvester
Kasanga, Godfrey
Kayange, Neema
Kidenya, Benson R.
Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study
title Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study
title_full Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study
title_fullStr Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study
title_full_unstemmed Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study
title_short Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study
title_sort predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at bugando medical centre, mwanza, tanzania: a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732094/
https://www.ncbi.nlm.nih.gov/pubmed/33306722
http://dx.doi.org/10.1371/journal.pone.0243636
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