Objective:
To determine early predictors of treatment failure in children 2 to 59 months, with community acquired very severe pneumonia.
Design: Prospective observational study.
Setting: Pediatric Emergency service, PGIMER, Chandigarh.
Materials and Methods:
Data of 166 children, aged 2-59 months with very severe pneumonia enrolled in a randomized trial to compare efficacy of Chloramphenicol with Ampicillin + Gentamicin was analyzed. Patients with prior antibiotic therapy, heat disease, duration of illness> 10 days were not included in the study. Treatment failure was defined as death, LAMA, occurrence of shock, renal failure, empyema or meningitis or persistence/worsening of symptoms (using pre-defined criteria) requiring change in antibiotic therapy anytime after enrollment. Data was analyzed using t-test, chi-square test and multivariate regression analysis.
Results:
29 (17.4%) children had treatment failure including 4 death and 1 LAMA. Patients with treatment failure had significantly longer duration of dyspnea, lower systolic blood pressure, higher temperature and lower oxygen saturation at admission. On multivariate analysis, duration of dyspnea (odds ratio and 95% CI - 0.52, (0.303-0.893), oxygen saturation (0.98, 0.97-0.99), blood glucose 1.0 and total leukocyte count (0.97, 0.95-0.99) were significant predictors of treatment failure.
Conclusion:
Duration of dyspnea, hypoxemia, hypoxemia, hypoglycemia at admission may help in early identification of children with very severe pneumonia likely to have treatment failure and thus plan more appropriate treatment.
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