Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan
Objective Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. However, changing to alternative antimicrobial agents, such as amoxicillin, is...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
World Health Organization
2005
|
| Subjects: | |
| Online Access: | http://irep.iium.edu.my/28695/ http://irep.iium.edu.my/28695/ http://irep.iium.edu.my/28695/1/15609427.pdf |
| id |
iium-28695 |
|---|---|
| recordtype |
eprints |
| spelling |
iium-286952013-02-13T08:49:18Z http://irep.iium.edu.my/28695/ Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan Rasmussen, Zeba A. Bari, Abdul Qazi, Shamim Rehman, Gul Azam, Iqbal Khan, SherBaz Aziz, Farida Rafi, Sadia Roghani, Mehr Taj Iqbal, Imran Nagi, Abdul Ghaffar Hussain, Waqar Bano, Nahida van Latum, late J.C. Khan, Mushtaq RJ Pediatrics Objective Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. However, changing to alternative antimicrobial agents, such as amoxicillin, is costly. We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus double dosage for treating non-severe pneumonia in children. Methods A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community health programmes. A total of 1143 children aged 2–59 months with non-severe pneumonia were randomly allocated to receive 4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body weight orally twice-daily for 5 days Treatment failure occurred when a child required a change of therapy, died or was lost to follow-up. Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours after enrolment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower than at the time of enrolment). Findings The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double dose. Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10; 95% confidence interval = 0.87–1.37). Using multivariate analysis we found that treatment was more likely to fail in children who were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics previously (P = 0.002), those whose respiratory rate was 20 breaths/minute above the age-specific cut-off point (P = 0.006), and those from urban areas (P = 0.042). Conclusion Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia. Close followup of patients is essential to prevent worsening of disease. Definitions of clinical failure need to be more specific. Surveillance in both rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes. World Health Organization 2005-01 Article PeerReviewed application/pdf en http://irep.iium.edu.my/28695/1/15609427.pdf Rasmussen, Zeba A. and Bari, Abdul and Qazi, Shamim and Rehman, Gul and Azam, Iqbal and Khan, SherBaz and Aziz, Farida and Rafi, Sadia and Roghani, Mehr Taj and Iqbal, Imran and Nagi, Abdul Ghaffar and Hussain, Waqar and Bano, Nahida and van Latum, late J.C. and Khan, Mushtaq (2005) Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan. Bulletin of the World Health Organization, 83 (1). pp. 10-19. ISSN 0042-9686 http://www.who.int/bulletin/en/ |
| repository_type |
Digital Repository |
| institution_category |
Local University |
| institution |
International Islamic University Malaysia |
| building |
IIUM Repository |
| collection |
Online Access |
| language |
English |
| topic |
RJ Pediatrics |
| spellingShingle |
RJ Pediatrics Rasmussen, Zeba A. Bari, Abdul Qazi, Shamim Rehman, Gul Azam, Iqbal Khan, SherBaz Aziz, Farida Rafi, Sadia Roghani, Mehr Taj Iqbal, Imran Nagi, Abdul Ghaffar Hussain, Waqar Bano, Nahida van Latum, late J.C. Khan, Mushtaq Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan |
| description |
Objective Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for
treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. However, changing to alternative
antimicrobial agents, such as amoxicillin, is costly. We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus
double dosage for treating non-severe pneumonia in children.
Methods A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community
health programmes. A total of 1143 children aged 2–59 months with non-severe pneumonia were randomly allocated to receive
4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body
weight orally twice-daily for 5 days Treatment failure occurred when a child required a change of therapy, died or was lost to follow-up.
Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours
after enrolment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower
than at the time of enrolment).
Findings The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double
dose. Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10;
95% confidence interval = 0.87–1.37). Using multivariate analysis we found that treatment was more likely to fail in children who
were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics
previously (P = 0.002), those whose respiratory rate was 20 breaths/minute above the age-specific cut-off point (P = 0.006),
and those from urban areas (P = 0.042).
Conclusion Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia. Close followup
of patients is essential to prevent worsening of disease. Definitions of clinical failure need to be more specific. Surveillance in both
rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes. |
| format |
Article |
| author |
Rasmussen, Zeba A. Bari, Abdul Qazi, Shamim Rehman, Gul Azam, Iqbal Khan, SherBaz Aziz, Farida Rafi, Sadia Roghani, Mehr Taj Iqbal, Imran Nagi, Abdul Ghaffar Hussain, Waqar Bano, Nahida van Latum, late J.C. Khan, Mushtaq |
| author_facet |
Rasmussen, Zeba A. Bari, Abdul Qazi, Shamim Rehman, Gul Azam, Iqbal Khan, SherBaz Aziz, Farida Rafi, Sadia Roghani, Mehr Taj Iqbal, Imran Nagi, Abdul Ghaffar Hussain, Waqar Bano, Nahida van Latum, late J.C. Khan, Mushtaq |
| author_sort |
Rasmussen, Zeba A. |
| title |
Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan |
| title_short |
Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan |
| title_full |
Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan |
| title_fullStr |
Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan |
| title_full_unstemmed |
Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan |
| title_sort |
randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in pakistan |
| publisher |
World Health Organization |
| publishDate |
2005 |
| url |
http://irep.iium.edu.my/28695/ http://irep.iium.edu.my/28695/ http://irep.iium.edu.my/28695/1/15609427.pdf |
| first_indexed |
2023-09-18T20:42:15Z |
| last_indexed |
2023-09-18T20:42:15Z |
| _version_ |
1777409442820653056 |