Drugs

, Volume 65, Issue 9, pp 1179–1192 | Cite as

Short-Course Therapy for Community-Acquired Pneumonia in Paediatric Patients

Leading Article

Abstract

Studies conducted over the past few years for the treatment of pneumonia have provided data on the basis of which therapeutic decisions concerning the duration of therapy can be taken.

Results from a majority of the studies conducted in hospitalised patients using the conventional methods for diagnosing pneumonia have methodological problems, which make it difficult to draw definite conclusions. Despite these limitations, the overall trend of these descriptive studies show a therapy of ≤5 days being as effective as the longer course of 7–14 days for children up to the age of 12 years. Data for duration of antibacterial therapy for infants <2 months of age hardly exists.

Evidence suggests that a shorter course of antibacterial therapy of 3 days is effective for treatment of community-acquired, non-severe ambulatory pneumonia in immunocompetent children aged 2–59 months old. Shorter duration of therapy offers several potential advantages that include prevention of the emergence of antimicrobial resistance, lower healthcare costs, improved adherence to therapy and fewer adverse effects. There is a need to improve the evidence base for the optimum duration of therapy for children hospitalised with severe pneumonia.

Keywords

Pneumonia Respiratory Syncytial Virus Antimicrobial Resistance Antibacterial Therapy Severe Pneumonia 

Notes

Acknowledgements

© World Health Organization 2005. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article.

References

  1. 1.
    Williams BG, Gouws E, Boschi-Pinto C, et al. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002 Jan; 2(1): 25–32PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization. The world health report 2005. Make every mother and child count. Geneva: World Health Organization, 2005: 190 [online]. Available from URL: http://www.who.int/whr/2005/whr2005_en.pdf [Accessed 2005 Apr21]Google Scholar
  3. 3.
    Shann F, Barker J, Poore P. Clinical signs that predict death in children with severe pneumonia. Pediatr Infect Dis J 1989; 8: 852–5PubMedCrossRefGoogle Scholar
  4. 4.
    Qazi SA, Rehman GN, Khan MA. Standard ARI case management on antibiotic use and case fatality on ARI patients at a Children’s Hospital in Pakistan. Bull World Health Organ 1996; 74: 501–7PubMedGoogle Scholar
  5. 5.
    Duke T, Poka H, Dale F, et al. Chloramphenicol versus benzylpenicillin and gentamicin for the treatment of severe pneumonia in children in Papua New Guinea: a randomised trial. Lancet 2002 Feb 9; 359(9305): 474–80PubMedCrossRefGoogle Scholar
  6. 6.
    Djelantik IGG, Gessner BD, Sutanto A, et al. Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting. J Trop Pediatr 2003; 49: 327–32PubMedCrossRefGoogle Scholar
  7. 7.
    McIntosh K. Community-acquired pneumonia in children. N Engl J Med 2002 Feb 7; 346(6): 429–37PubMedCrossRefGoogle Scholar
  8. 8.
    Ruuskanen O, Mertsola J. Childhood community-acquired pneumonia. Semin Respir Infect 1999; 14: 163–72PubMedGoogle Scholar
  9. 9.
    Korppi M. Community-acquired pneumonia in children: issues in optimizing antibacterialtreatment. Paediatr Drugs 2003; 5: 821–32PubMedCrossRefGoogle Scholar
  10. 10.
    Korppi M, Heiskanen-Kosma T, Kleemola M. Incidence of community-acquired pneumonia in children caused by Mycoplasmapneumoniae: serological results of a prospective, population-based study in primary health care. Respirology 2004; 9: 109–14PubMedCrossRefGoogle Scholar
  11. 11.
    Heiskanen-Kosma T, Korppi M, Laurila A, et al. Chlamydia pneumoniae is an important cause of community-acquired pneumonia in school-aged children: serological results of a prospective, population-based study. Scand J Infect Dis 1999; 31: 255–9PubMedCrossRefGoogle Scholar
  12. 12.
    Principi N, Esposito S. Emerging role of Mycoplasma pneumoniae and Chlamydia pneumoniae in paediatric respiratory-tract infections. Lancet Infect Dis 2001; 1: 334–44PubMedCrossRefGoogle Scholar
  13. 13.
    Ghafoor A, Nomani NK, Ishaq Z, et al. Diagnoses of acute lower respiratory tract infection in children in Rawalpindi and Islamabad, Pakistan. Rev Infect Dis 1990; 12 Suppl. 8: S907–14PubMedCrossRefGoogle Scholar
  14. 14.
    Tupasi TE, Lucero MG, Magdangal DM, et al. Etiology of acute lower respiratory tract infection in children from Alabang, Metro Manila. Rev Infect Dis 1990; 12 Suppl. 8: S929–39PubMedCrossRefGoogle Scholar
  15. 15.
    Mastro TD, Ghafoor A, Nomani NK, et al. Antimicrobial resistance of pneumococci in children with acute lower respiratory tract infection in Pakistan. Lancet 1991; 337(8734): 156–9PubMedCrossRefGoogle Scholar
  16. 16.
    Weinberg GA, Spitzer ED, Murray PR, et al. Antimicrobial susceptibility patterns of Haemophilus isolates from children in eleven developing nations. Bull World Health Organ 1990; 68: 179–84PubMedGoogle Scholar
  17. 17.
    Straus WL, Qazi SA, Kundi Z, et al. Antimicrobial resistance and clinical effectiveness of co-trimoxazole versus amoxicillin for pneumonia among children in pakistan: randomised controlled trial. Lancet 1998, 74Google Scholar
  18. 18.
    Berkley JA, Maitland K, Mwangi I, et al. Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. BMJ. Epub 2005 Mar 29Google Scholar
  19. 19.
    Baqui AH, Black RE, Arifeen SE, et al. Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study. Bull World Health Organ 1998; 76: 161–71PubMedGoogle Scholar
  20. 20.
    Bulla A, Hitze KL. Acute respiratory infections: a review. Bull World Health Organ 1978; 56: 481–98PubMedGoogle Scholar
  21. 21.
    World Health Organization (WHO). Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities. Programme for the Control of Acute Respiratory Infections. Geneva: WHO, 1991: WHO.ARI.91.20 [online]. Available from URL: http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTHAVHO.ARI.91.20.pdf [Accessed 2005 Apr22]Google Scholar
  22. 22.
    Shann F. Etiology of severe pneumonia in children in developing countries. Pediatr Infect Dis 1986; 5: 247–52PubMedCrossRefGoogle Scholar
  23. 23.
    Forgie IM, O’Neill KP, Lloyd-Evans N, et al. Etiology of acute lower respiratory tract infections in Gambian children. II: acute lower respiratory tract infection in children ages one to nine years presenting at the hospital. Pediatr Infect Dis J 1991; 10: 42–7PubMedCrossRefGoogle Scholar
  24. 24.
    Falade AG, Mulholland EK, Adegbola RA, et al. Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. Ann Trop Paediatr 1997; 17: 315–9PubMedGoogle Scholar
  25. 25.
    Vuori-Holopainen E, Salo E, Saxen H, et al. Etiological diagnosis of childhood pneumonia by use of transthoracic needle aspiration and modern microbiological methods. Clin Infect Dis 2002; 34: 583–90. Epub 2002 Jan 16PubMedCrossRefGoogle Scholar
  26. 26.
    Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993; 137: 977–88PubMedGoogle Scholar
  27. 27.
    Murphy TF, Henderson FW, Clyde Jr WA, et al. Pneumonia: an eleven-year study in a pediatric practice. Am J Epidemiol 1981; 113: 12–21PubMedGoogle Scholar
  28. 28.
    World Health Organization. Acute respiratory infections in children: case management in small hospitals in developing countries: a manual for doctors and other senior health workers. programme for the control of acute respiratory infections. WHO/ARI/90.5. Geneva: World Health Organization, 1990Google Scholar
  29. 29.
    Leventhal JM. Clinical predictors of pneumonia as a guide to ordering chest roentgenograms. Clin Pediatr 1982; 21: 730–4CrossRefGoogle Scholar
  30. 30.
    Shann F, Hart K, Thomas D. Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull World Health Organ 1984; 62: 749–53PubMedGoogle Scholar
  31. 31.
    Redd SC, Vreuls R, Metsing M, et al. Clinical signs of pneumonia in children attending a hospital outpatient department in Lesotho. Bull World Health Organ 1994; 72: 113–8PubMedGoogle Scholar
  32. 32.
    Campbell H, Byass P, Greenwood BM. Simple signs for diagnosis of acute respiratory infections. Lancet 1988; II: 742–3CrossRefGoogle Scholar
  33. 33.
    Cherian T, John TJ, Simoes E, et al. Evaluation of simple clinical signs for the diagnosis of acute lower respiratory tract infection. Lancet 1988; II: 125–8CrossRefGoogle Scholar
  34. 34.
    Berman S, Simoes EA, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child 1991; 66: 81–4PubMedCrossRefGoogle Scholar
  35. 35.
    Mulholland EK, Simoes EA, Costales MO, et al. Standardized diagnosis of pneumonia in developing countries. Pediatr Infect Dis J 1992; 11: 77–81PubMedCrossRefGoogle Scholar
  36. 36.
    Bettenay FA, de Campo JF, McCrossin DB. Differentiating bacterial from viral pneumonias in children. Pediatr Radiol 1988; 18: 453–4PubMedCrossRefGoogle Scholar
  37. 37.
    Courtoy I, Lande AE, Turner RB. Accuracy of radiographic differentiation of bacterial from nonbacterial pneumonia. Clin Pediatr 1989; 28: 261–4CrossRefGoogle Scholar
  38. 38.
    Juven T, Mertsola J, Waris M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 2000 Apr; 19(4): 293–8PubMedCrossRefGoogle Scholar
  39. 39.
    Korppi M, Leinonen M, Koskela M, et al. Bacterial coinfection in children hospitalized with respiratory syncytial virus infections. Pediatr Infect Dis J 1989 Oct; 8(10): 687–92PubMedCrossRefGoogle Scholar
  40. 40.
    Hietala J, Uhari M, Tuokko H, et al. Mixed bacterial and viral infections are common in children. Pediatr Infect Dis J 1989; 8: 683–6PubMedCrossRefGoogle Scholar
  41. 41.
    Korppi M. Mixed microbial aetiology of community-acquired pneumonia in children. APMIS 2002; 110: 515–22PubMedCrossRefGoogle Scholar
  42. 42.
    Klein JO. Bacterial pneumonias. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious diseases. 4th ed. Philadelphia (PA): WB Saunders, 1998: 83Google Scholar
  43. 43.
    Prober CG. Pneumonia. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 16th ed. Philadelphia (PA): WB Saunders, 2000: 761–5Google Scholar
  44. 44.
    American Academy of Pediatrics 2000 red book: report of the committee on infectious diseases. 25th ed. Elk Grove Village (IL): American Academy of Pediatrics, 2000: 262–65, 452–57Google Scholar
  45. 45.
    Pichichero ME. Short course antibiotic therapy for respiratory infections: a review of the evidence. Pediatr Infect Dis J 2000 Sep; 19(9): 929–37PubMedCrossRefGoogle Scholar
  46. 46.
    Jadavji T, Law B, Lebel MH, et al. A practical guide for the diagnosis and treatment of pediatric pneumonia. CMAJ 1997; 156: S703–11PubMedGoogle Scholar
  47. 47.
    American Academy of Pediatrics. Therapy for children with invasive pneumococcal infections: American Academy of Pediatrics Committee on Infectious Diseases. Pediatrics 1997: 99: 289–99CrossRefGoogle Scholar
  48. 48.
    McCracken Jr GH. Diagnosis and management of pneumonia in children. Pediatr Infect Dis J 2000; 19: 924–8PubMedCrossRefGoogle Scholar
  49. 49.
    British Thoracic Society. Guidelines for the management of community acquired pneumonia in children. Thorax 2002; 57: i1–i24Google Scholar
  50. 50.
    World Health Organization. The management of acute respiratory infections in children: practical guidelines for outpatient care. Geneva: World Health Organization, 1995Google Scholar
  51. 51.
    Sazawal S, Black RE. Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a metaanalysis of community-based trials. Lancet Infect Dis 2003; 3: 547–56PubMedCrossRefGoogle Scholar
  52. 52.
    Berman S. Epidemiology of acute respiratory infections. Rev Infect Dis 1991; 13 Suppl. 6: S454–62PubMedCrossRefGoogle Scholar
  53. 53.
    Pechere JC. Parameters important in short antibiotic courses. J Int Med Res 2000; 28 Suppl. 1: 3A–12APubMedGoogle Scholar
  54. 54.
    Dagan R, Leibovitz E. Bacterial eradication in the treatment of otitis media. Lancet Infect Dis 2002; 2: 593–604PubMedCrossRefGoogle Scholar
  55. 55.
    Wood MJ. Therapy: the clinician’s view. J Antimicrob Chemother 1990; 25 Suppl. C: 99–106PubMedCrossRefGoogle Scholar
  56. 56.
    Gold HS, Moellering Jr RC. Antimicrobial-drug resistance. N Engl J Med 1996; 335: 1445–53PubMedCrossRefGoogle Scholar
  57. 57.
    Guillemot D, Carbon C, Balkau B, et al. Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA 1998; 279: 365–70PubMedCrossRefGoogle Scholar
  58. 58.
    Seppala H, Klaukka T, Vuopio-Varkila J, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland: Finnish Study Group for Antimicrobial Resistance. N Engl J Med 1997; 337: 441–6PubMedCrossRefGoogle Scholar
  59. 59.
    World Health Organization. WHO global strategy for containment of antimicrobial resistance. WHO/CDS/CSR/DRS/2001.2. Geneva: WHO, 2001Google Scholar
  60. 60.
    Steinke D, Davey P. Association between antibiotic resistance and community prescribing: a critical review of bias and confounding in published studies. Clin Infect Dis 2001 Sep 15; 33 Suppl. 3: S193–205PubMedCrossRefGoogle Scholar
  61. 61.
    Tenover FC. Development and spread of bacterial resistance to antimicrobial agents: an overview. Clin Infect Dis 2001 Sep 15; 33 Suppl. 3: S108–15PubMedCrossRefGoogle Scholar
  62. 62.
    Schrag SJ, Pena C, Fernandez J, et al. Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomized trial. JAMA 2001; 286: 49–56PubMedCrossRefGoogle Scholar
  63. 63.
    Standing Medical Advisory Committee, Sub-Group on Antimicrobial Resistance. The path of least resistance. London: Department of Health, 1998Google Scholar
  64. 64.
    Kristinsson KG. Effect of antimicrobial use and other risk factors on antimicrobial resistance in pneumococci. Microb Drug Resist 1997; 3: 117–23PubMedCrossRefGoogle Scholar
  65. 65.
    Campbell H. Acute respiratory infection: a global challenge. Arch Dis Child 1995; 73: 281–6PubMedCrossRefGoogle Scholar
  66. 66.
    Adam D. Short-course antibiotic therapy for infections with a single causative pathogen. J Int Med Res 2000; 28 Suppl. 1: 13A–24APubMedGoogle Scholar
  67. 67.
    Tulloch J. Integrated approach to child health in developing countries. Lancet 1999 Sep; 354 Suppl. II: SII16–20PubMedCrossRefGoogle Scholar
  68. 68.
    Harris CM, Lloyd DC. Consider short courses of antibiotics [letter]. BMJ 1994; 308: 919PubMedCrossRefGoogle Scholar
  69. 69.
    Al-Eidan FA, McElnay JC, Scott MG, et al. Sequential antimicrobial therapy: treatment of severe lower respiratory tract infections in children. J Antimicrob Chemother 1999; 44: 709–15PubMedCrossRefGoogle Scholar
  70. 70.
    Bergman AB, Werner RJ. Failure of children to receive penicillin by mouth. N Engl J Med 1963; 268: 1334–8PubMedCrossRefGoogle Scholar
  71. 71.
    Pechere JC. Patients’ interviews and misuse of antibiotics. Clin Infect Dis 2001; 33 Suppl. 3: S170–3PubMedCrossRefGoogle Scholar
  72. 72.
    Branthwaite A, Pechere JC. Pan-European survey of patients’ attitudes to antibiotics and antibiotic use. J Int Med Res 1996; 24: 229–38PubMedGoogle Scholar
  73. 73.
    Roord JJ, Wolf BH, Gossens MM, et al. Prospective open randomized study comparing efficacies and safeties of a 3-day course of azithromycin and a 10-day course of erythromycin in children with community-acquired acute lower respiratory tract infections. Antimicrob Agents Chemother 1996; 40: 2765–8PubMedGoogle Scholar
  74. 74.
    Schaad U. Multicentre evaluation of azithromycin in comparison with co-amoxyclav for the treatment of acute otitis media in children. J Antimicrob Chemother 1993; 31 Suppl. E: 81–8PubMedCrossRefGoogle Scholar
  75. 75.
    Gehanno P, Taillebe M, Denis P, et al. Short-course cefotaxime compared with five-day co-amoxyclav in acute otitis media in children. J Antimicrob Chemother 1990; 26 Suppl. A: 29–36PubMedCrossRefGoogle Scholar
  76. 76.
    Gooch WM, Blair E, Puopolo A, et al. Effectiveness of five days of therapy with cefuroxime axetil suspension for treatment of acute otitis media. Pediatr Infect Dis J 1996; 15: 157–64PubMedCrossRefGoogle Scholar
  77. 77.
    Khurana CM. A multicenter, randomized, open label comparison of azithromycin and amoxicillin/clavulanate in acute otitis media among children attending day care or school. Pediatr Infect Dis J 1996; 15 (9 Suppl.): S24–9PubMedCrossRefGoogle Scholar
  78. 78.
    Hoberman A, Paradise JL, Burch DJ, et al. Equivalent efficacy and reduced occurrence of diarrhea from a new formulation of amoxicillin/clavulanate potassium (Augmentin) for the treatment of otitis media in children. Pediatr Infect Dis J 1997; 16: 463–70PubMedCrossRefGoogle Scholar
  79. 79.
    Cohen R, Navel M, Grunberg J, et al. One dose ceftiaxone vs ten days of amoxicillin/clavulanate therapy for acute otitis media. Pediatr Infect Dis J 1999; 18: 403–9PubMedCrossRefGoogle Scholar
  80. 80.
    Roos K, Larsson P. Efficacy of ceftibuten in 5 vs 10 days treatment of recurrent otitis media in children. Int J Pediatr Otorhinolaryngol 2000; 55: 109–15PubMedCrossRefGoogle Scholar
  81. 81.
    Paradise JL. Managing otitis media: a time for change. Pediatrics 1995; 96 (4 Pt 1): 712–5PubMedGoogle Scholar
  82. 82.
    Dowell SF, Marcy SM, Phillips WR, et al. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998; 101: 163–5Google Scholar
  83. 83.
    Lambert HP. Don’t keep taking the tablets? Lancet 1999; 354: 943–5PubMedCrossRefGoogle Scholar
  84. 84.
    Sutton DR, Wicks ACB, Davidson L. One-day treatment for lobar pneumonia. Thorax 1970; 25: 241–4PubMedCrossRefGoogle Scholar
  85. 85.
    Sibellas M. Treatment of lobar pneumonia in out-patients. J Trop Med Hyg 1966; 69: 94–6PubMedGoogle Scholar
  86. 86.
    Harris JA, Kolokathis A, Campbell M, et al. Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J 1998; 17: 865–71PubMedCrossRefGoogle Scholar
  87. 87.
    Wubbel L, Muniz L, Ahmed A, et al. Etiology and treatment of community-acquired pneumonia in ambulatory children. Pediatr Infect Dis J 1999; 18: 98–104PubMedCrossRefGoogle Scholar
  88. 88.
    Kogan R, Martinez MA, Rubilar L, et al. Comparative randomized trial of azithromycin versus erythromycin and amoxicillin for treatment of community-acquired pneumonia in children. Pediatr Pulmonol 2003; 35: 91–8PubMedCrossRefGoogle Scholar
  89. 89.
    Ficnar B, Huzjak N, Oreskovic K, et al. Azithromycin: 3-day versus 5-day course in the treatment of respiratory tract infections in children. Croatian Azithromycin Study Group. J Chemother 1997; 9: 38–43PubMedGoogle Scholar
  90. 90.
    Langtry HD, Balfour JA. Azithromycin: a review of its use in paediatric infectious diseases. Drugs 1998; 56(2): 273–97PubMedCrossRefGoogle Scholar
  91. 91.
    Gordon EM, Blumer JL. Rationale for single and high dose treatment regimens with azithromycin. Pediatr Infect Dis J 2004; 23 (2 Suppl.): S102–7PubMedCrossRefGoogle Scholar
  92. 92.
    Campbell H, Byass P, Forgie IM, et al. Trial of co-trimoxazole versus procaine penicillin with ampicillin in treatment of community-acquired pneumonia in young Gambian children. Lancet 1988; II: 1182–4CrossRefGoogle Scholar
  93. 93.
    Keeley DJ, Nkrumah FK, Kapuyanyika C. Randomized trial of sulfamethoxazole + trimethoprim versus procaine penicillin for the outpatient treatment of childhood pneumonia in Zimbabwe. Bull World Health Organ 1990; 68: 185–92PubMedGoogle Scholar
  94. 94.
    Catchup Study Group. Clinical efficacy of co-trimoxazole versus amoxicillin twice daily for treatment of pneumonia: a randomised controlled clinical trial in Pakistan. Arch Dis Child 2002; 86: 113–8CrossRefGoogle Scholar
  95. 95.
    Rasmussen ZA, Bari A, Qazi S, et al., for the Pakistan COMET (Cotrimoxazole Multicentre Efficacy Trial) Study Group. Randomised controlled trial of standard and double dose cotrimoxazole for treatment of childhood pneumonia in Pakistan. Bull World Health Organ 2005; 83: 10–9PubMedGoogle Scholar
  96. 96.
    Vuori-Holopainen E, Peltola H, Kallio MJ. Narrow-versus broad-spectrum parenteral anatimicrobials against common infections of childhood: a prospective and randomised comparison between penicillin and cefuroxime. SE-TU Study Group. Eur J Pediatr 2000; 159: 878–84PubMedCrossRefGoogle Scholar
  97. 97.
    Peltola H, Vuori-Holopainen E, Kallio MJ. Successful shortening from seven to four days of parenteral beta-lactam treatment for common childhood infections: a prospective and randomized study. SE-TU Study Group. Int J Infect Dis 2001; 5: 3–8PubMedCrossRefGoogle Scholar
  98. 98.
    Pakistan Multicentre Amoxicillin Short Course Therapy (MASCOT) Pneumonia Study Group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet 2002; 360: 835–41CrossRefGoogle Scholar
  99. 99.
    Qazi S. Oral amoxicillin for childhood pneumonia. Lancet 2003; 361: 76–7CrossRefGoogle Scholar
  100. 100.
    ISCAP Study Group. 3-versus 5-day treatment with amoxicillin for non-severe pneumonia in young children: a multi-centre randomized trial. BMJ 2004; 328: 791–7. Epub 2004 Mar 16CrossRefGoogle Scholar
  101. 101.
    Kartasasmita C, Saha S, Short Course Cotrimoxazole Study Group. Three days vs five days oral cotrimoxazole therapy in non-severe pneumonia. In: Consultative Meeting to Review Evidence and Research Priorities in the Management of Acute Respiratory Infections (ARI). Geneva, World Health Organization, 2003 Sep 29–Oct 1: meeting report. Geneva: Department of Child and Adolescent Health and Development, World Health Organization, 2004: 3–4. Report no. WHO/FCH/CAH/04.2 [online]. Available from URL: http://www.who.int/child-adolescent-health/New.Publications/CHILD.HEALTH/WHO_FCH_CAH_04.2.pdf [Accessed 2005 Apr 22]Google Scholar
  102. 102.
    World Health Organization. Report of consultative meeting to review evidence and research priorities in the management of acute respiratory infections (ARI). Geneva: 2003 Sep 29–Oct 1. WHO/FCH/CAH/04.2 [online]. Available from URL: http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTHAVHO_FCH_CAH_04.2.pdf [Accessed 2005 Apr 22]

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Department of Child and Adolescent Health and DevelopmentWorld Health OrganizationGenevaSwitzerland

Personalised recommendations