Community case management of severe pneumonia

摘要

Although the results of the cluster-randomised trial by Abdul Bari and colleagues (Nov 19, p 1796)1 support community case management of severe pneumonia, some caution needs to be entertained before widespread deployment2 and adoption into WHO and country policies.Infants and children with WHO-defined pneumonia (fast breathing) were treated with amoxicillin in accordance with WHO guidelines.3 However, case fatality ratios in those with pneumonia were presumably low, since it was less than one per 1000 in children with severe pneumonia, yet community case management could have resulted in administration of oral antibiotics to 19 221 of 76 734 children (15749 with non-severe pneumonia and 3472 with severe pneumonia). Given the financial cost and the cost in terms of antibiotic resistance, I wonder whether community case management of pneumonia should be recommended in developing countries?