Pharmacotherapy of pneumonia in children under five years in two hospitals in the Ashanti Region of Ghana.

Pneumonia is a major cause of morbidity and mortality in children under five years of age globally with a record of 2 million deaths per year. Africa alone accounts for about half of global childhood mortality cases. In Ghana, pneumonia is the third leading cause of childhood mortality. This study was aimed at determining the responses of patients to the antibiotics and the relevance of adjunctive therapies in the management of pneumonia in children under five years at Kumasi South Hospital (KSH) in Kumasi metropolis and Agogo Presbyterian Hospital (APH) in the Asante-Akyem North District both in the Ashanti Region of Ghana from January, 2015 to November, 2015. A prospective non-randomized observational study was conducted on a total of 189 children with confirmed pneumonia. Ninety-nine children were involved at KSH and 90 children at APH. A pneumonia case was selected after re-examination of the patient previously seen by resident clinicians during the day. Data collected include patient’s demographic information, type of pneumonia diagnosed, investigations and antibiotic and adjunctive therapies of the study subjects. The effectiveness of the treatments were measured using the length of stay on admission, and the overall health status and wellbeing of the patients after pneumonia therapy. Safety of antibiotics was assessed with reports of adverse reactions. At APH, 60% (n=54) were males and 40% (n=36) were females while 52% (n=52) were females and 47.5% (n=47) were males at KSH. Total out-patients were 50% (n=45) and in-patients were 50% (n=45) at APH. At KSH, total out-patients were 14.1% (n=14) and in-patients were 85.9% (n=85). At APH, oral cefuroxime or oral amoxicillin were the first-line antibiotics and oral erythromycin and oral co-amoxiclav were the second-line antibiotics for out-patients. For in-patients, iv ampicillin or iv cefuroxime combined with iv gentamicin were the first-line antibiotics while iv co-amoxiclav was the second-line antibiotics administered to in-patients. At KSH, first-line antibiotics were oral cefuroxime or oral amoxicillin for out-patients. For in-patients, iv cefuroxime combined with iv gentamicin were the first-line antibiotics while iv ceftriazone or iv co-amoxiclav were the second-line antibiotics. The main adjunctive treatments at APH were analgesics and antipyretics (paracetamol and ibuprofen) and oxygen. Others were ephedrine nasal drops, haematinics, saline nasal drops, multivitamin, ORS, iv fluids, steroids, vitamin K and blood and vitamin A. Adjunctive treatments at KSH include saline nasal drops, cough mixture, haematinics, ventolin inhaler and prednisolone. Others were ORS, zinc and vitamin C. At APH, the lengths of stay of patients on admission were one day (8.9%, n=8), two days (7.8%, n=7), three days (13.3%, n=12), four days (8.9%, n=8), five days (6.7%, n=6) and more than five days (4.4%, n=4). For KSH, the lengths of stay on admission were one day (4.7%, n=4), two days (18.8%, n=16), three days (24.7%, n=21), four days (10.6%, n=9), five days (10.6%, n=9) and more than five days (30.6%, n=26). At APH, clinical improvement recorded for first-line antibiotic therapy was 96.7%(n=87) and for second-line antibiotic therapy was 1.1%(n=1). Mortality recorded was 2.2%(n=2). At KSH, 89.9%(n=89) improved on first-line antibiotic therapy while 10.1%(n=10) improved on second-line antibiotic therapy. Oral amoxicillin and oral cefuroxime were effective first-line antibiotics for out-patient treatment of pneumonia. Intravenous ampicillin or iv cefuroxime combined with gentamicin were used as first line antibiotics for in-patient treatment of pneumonia. Co-amoxiclav, ceftriazone and erythromycin were effective second-line antibiotics.

Source: KNUST