A RANDOMIZED TRIAL OF CHLORAMPHENICOL VS TRIMETHOPRIM-SULFAMETHOXAZOLE FOR THE TREATMENT OF MALNOURISHED CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA

Children in developing countries who present with malnutrition often h ave infections, particularly pneumonia, at the time of presentation. W e evaluated the initial antibiotic management of 144 Gambian children who presented for the first time with malnutrition and who had clinica l or radiologic evidence of pneumonia. They were enrolled in a double blind trial of trimethoprim-sulfamethoxazole vs. chloramphenicol. Most children in the study underwent detailed investigations of bacterial and viral etiology as part of another study. The study drug was admini stered for a week along with oral metronidazole, vitamins and standard ized nutritional therapy. Treatment failure was defined as the need fo r change to parenteral antibiotics during treatment, failure to respon d to a week of treatment with the study drug or relapse during the fol lowing 2 weeks. There were no differences between the treatment groups in the clinical indicators of severity, etiology or radiologic findin gs. Thirty-three children were excluded from the analysis because of t uberculosis, inappropriate enrollment or inadequate follow up. Of the 111 children remaining, 32 (16 in each arm of the study) failed treatm ent. Clinical failure was not related to in vitro antimicrobial resist ance in the 20 cases in which invasive bacterial isolates were obtaine d. Those who failed treatment were more likely to have had lower chest wall indrawing and positive bacterial cultures than those who were su ccessfully treated. In an area with infrequent antimicrobial resistanc e of common respiratory pathogens, oral chloramphenicol and trimethopr im-sulfamethoxazole were equally effective in the initial management o f malnourished children with community-acquired pneumonia.