Antibiotic use in infants hospitalised with HIV-related pneumonia in Harare, Zimbabwe

Abstract

Objective: To describe the clinical features of infants admitted with HIV-related pneumonia and to describe antibiotic use in relation to recommended treatment guidelines. Design: Case series. Setting: Paediatric medical wards of two University Teaching Hospitals, Parirenyatwa and Harare Central Hospitals. Subjects: 100 infants aged one to 12 months admitted with HIV-related pneumonia Main Outcome Measures: Mortality and antibiotic use in the two hospitals. Methods: Records of 100 infants admitted for 48 hours or more with features of HIV-related pneumonia were analysed for clinical features and antibiotic use. Results: 77% of patients were in the first six months of life with a peak age of two months and a median of four months (Q1 = 2, Q3 = 6). The median age of children admitted to Parirenyatwa hospital was 5.5 months (Q1 = 3, Q3 =7) and in Harare hospital it was three months (Q1 = 2, Q3 = 6). The difference was statistically significant, p=0.035. Fifty four percent of cases received penicillin, aminoglycoside and cotrimoxazole and overall only 30% of prescriptions complied with Essential Drug List of Zimbabwe (EDLIZ) recommendations for treatment of severe pneumonia in children with HIV infection. The overall mortality was 27.0%. The mortality in Harare Central Hospital was 40.4% and 15.7% in Parirenyatwa. The difference was statistically significant p= 0.005. Conclusion: The difficulties in establishing the cause of the pneumonia in infants with HIV infection was a contributory factor to lack of adherence to standard treatment guidelines. In countries with a high prevalence of HIV infection and with limited resources, a clinical case definition for Pneumocystis carinii pneumonia (PCP) is required as a measure to provide treatment for infants with HIV related pneumonia which is evidence based. This approach will also promote rational antibiotic prescribing and will contain cost.