The edition · Family Medicine
Five days of antibiotics for a child's pneumonia
Ten trials and nearly 9,000 children show short courses for non-severe community-acquired pneumonia fail no more often, and are far more likely to be finished. Plus small-team care in Singapore polyclinics, why a MUAC referral is not the same as treatment, and what a polypill does to blood pressure.
The edition in brief
Children's pneumonia: a meta-analysis of 10 randomised trials with 8,970 immunocompetent children with non-severe community-acquired pneumonia found no difference between 5 days or less of antibiotics and longer courses in treatment failure (RR 1.07, 0.93–1.24) or relapse (RR 1.04, 0.72–1.49). Children on short courses were about a third as likely to miss doses (RR 0.35). Teamlet care: a five-year matched analysis in Singapore polyclinics found that small teams of two family physicians, a nurse and a care coordinator produced small changes in HbA1c, blood pressure and LDL, but 16% more diabetic foot screens, 6% more eye screens, fewer admissions and an overall saving of about 2,186 Singapore dollars per patient. Malnutrition screening: within a trial in Burkina Faso, children whose mid-upper arm circumference fell just below the 11.5 cm referral cut-off did no better at the next census than those just above it; treatment uptake was not measured, and the mortality estimate was extremely imprecise. Polypill: nine studies and 6,264 patients found fixed-dose combinations lowered systolic and diastolic pressure slightly more than separate tablets, with small standardised effects.
Small-team polyclinic care raised diabetes screening and cut admissions over five years
Consider a small named team with a coordinator for chronic disease lists; expect gains in screening and admissions more than in lab values.
A MUAC referral alone did not change children's outcomes near the cut-off
When a child screens positive for severe acute malnutrition, check that treatment actually started, not only that referral was made.
Polypill lowered blood pressure slightly more than separate tablets
Consider a fixed-dose combination to simplify regimens where adherence is the barrier, choosing one with appropriate components.
Reassurance works better when you explain what the normal result rules out
Make reassurance specific: what was tested, what it rules out, and what would bring the patient back.
Five days or less of antibiotics for non-severe childhood pneumonia: same failure, better adherence
For non-severe childhood pneumonia in a well child, a 5-day course is a reasonable choice and more likely to be completed.
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