King et al developed model for predicting oral antibiotic treatment failure in a child with community-acquired pneumonia (CAP). This can help to identify a patient who may benefit from more aggressive management. The authors are from the University College London, Johns Hopkins University, McGill University, Kaiser Permanente Northwest, Bill and Melinda Gates Foundation and government agencies of Malawi.
Patient selection: pediatric patient with fast-breathing community-acquired pneumonia, age 2 to 59 months, not severely malnourished (severely malnourished patients referred)
Fast breathing pneumonia:
(1) cough and/or difficulty breathing
(2) fast breathing (> 50 breaths per minute for 2-11 months, > 40 breaths per minute for 12 to 59 months)
Parameters:
(1) age in months
(2) very fast breathing (> 70 breaths per minute for infants 2-11 months, > 60 breaths per minute for 12 to 59 months)
(3) hypoxemia (oxygen saturation < 95%)
(4) fever (>= 38°C)
(5) moderately malnourished
(6) doses of pentavalent vaccine
(7) doses of PCV (13 valent pneumococcal conjugate vaccine)
(8) concurrent malaria
|
Parameter |
Finding |
Points |
|
age in months |
2 to 5 months |
0.057 |
|
|
6 to 11 months |
-0.315 |
|
|
12 to 59 months |
0 |
|
very fast breathing |
no |
0 |
|
|
yes |
0.001 |
|
hypoxemia |
no |
0 |
|
|
yes |
0.441 |
|
fever |
no |
0 |
|
|
yes |
-0.495 |
|
malnourished |
no |
0 |
|
|
yes |
0.633 |
|
doses of pentavalent |
0 |
0 |
|
|
1 or 2 |
-1.267 |
|
|
3 |
0.189 |
|
doses of PCV |
0 |
0 |
|
|
1 or 2 |
0.621 |
|
|
3 |
0.284 |
|
malaria |
no |
0 |
|
|
yes |
0.480 |
X =
= SUM(points for all 8 parameters) – 2.475
probability of treatment failure =
= 1 / (1 + EXP((-1) * X))
Purpose: To identify a small child with fast breathing community-acquired pneumonia who may fail oral antibiotic therapy based on the model of King et al.
Specialty: Infectious Diseases, Pharmacology, clinical, Pulmonology
Objective: options, selection, failure handling and therapy escalation, response to therapy
ICD-10: J13, J14, J15, J18,
