Predictors and outcome of first line treatment failure among under-five children with community acquired severe pneumonia at Bugando Medical Centre, Mwanza, Tanzania: A prospective cohort study

Background Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP. Results A total of 250 children with SCAP with a median age of 18 [IQR 9-36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11-2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16-2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01-1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28-2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42-2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04-2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56-2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%. Conclusion Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality.