University of Washington, Seattle, Washington, USA.
University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi.
J Glob Health. 2021 Mar 7;11:04016. doi: 10.7189/jogh.11.04016.
Children with comorbidities or danger signs are often excluded from trials evaluating pneumonia treatment.
We sought to investigate whether the percentage of children with chest-indrawing pneumonia cured at Day 14 was lower among those with HIV infection or exposure, malaria, moderate or severe acute malnutrition, or anemia enrolled in a prospective observational cohort study than among children without these comorbidities enrolled in a concurrent prospective randomized controlled trial evaluating duration of amoxicillin treatment in Lilongwe, Malawi.
Children with chest-indrawing pneumonia and comorbidities but without danger signs did not have statistically significant higher treatment failure rates by Day 6 than those in the chest-indrawing pneumonia clinical trial. However, children with chest-indrawing pneumonia and HIV infection or exposure, malaria, or moderate or severe acute malnutrition had higher rates of not being clinically cured at Day 14 when compared to children without these comorbidities (adjusted differences ranging from 7.7% to 17.0%). Furthermore, among children without danger signs at enrollment, but with HIV infection or HIV exposure or moderate or severe acute malnutrition, 12.5% and 15.6% respectively were not clinically cured at Day 14 even though they were without treatment failure by Day 6.
More intensive follow-up of children with chest-indrawing pneumonia and comorbidities who do not have danger signs may be beneficial.
患有合并症或危险体征的儿童通常被排除在评估肺炎治疗效果的试验之外。
我们试图研究在马拉维利隆圭开展的一项前瞻性观察性队列研究中，与未患有这些合并症的儿童相比，感染艾滋病毒或接触艾滋病毒、疟疾、中重度急性营养不良或贫血的伴有胸腔凹陷性肺炎的儿童在第 14 天治愈的比例是否较低，这些儿童入组于评估阿莫西林治疗时间的同时进行的前瞻性随机对照试验。
患有胸腔凹陷性肺炎合并症但无危险体征的儿童，在第 6 天的治疗失败率与胸腔凹陷性肺炎临床试验中的儿童相比，没有统计学上的显著升高。然而，与无这些合并症的儿童相比，患有胸腔凹陷性肺炎且感染艾滋病毒或接触艾滋病毒、疟疾或中重度急性营养不良的儿童在第 14 天未达到临床治愈的比例更高（调整后的差异范围为 7.7%至 17.0%）。此外，在入组时无危险体征但感染艾滋病毒或艾滋病毒接触或中重度急性营养不良的儿童中，分别有 12.5%和 15.6%在第 14 天未达到临床治愈，尽管他们在第 6 天没有治疗失败。
对无危险体征的伴有胸腔凹陷性肺炎合并症的儿童进行更密切的随访可能是有益的。
