Benefits and risks Prevention of hypothermia immediately after birth in low birth

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6. Evidence for recommendations for treatment of pneumonia

6.1 Antibiotic treatment for non-severe pneumonia with wheeze

Antibiotics are not routinely recommended for children with non-severe pneumonia i.e. fast breathing with no chest indrawing or danger sign with a wheeze but with no fever temperature 38 °C, as the cause is most likely to be viral. Strong recommendation, low quality evidence his recommendation is applicable only in situations where the health workers are able to assess “wheeze”. he panel observed that there is evidence that WHO criteria for diagnosing pneumonia performs poorly in children with wheeze; that the addition of fever to WHO criteria improves diagnostic accuracy in this group of children; and that children with wheeze and no fever are very unlikely to have bacterial pneumonia.

6.1.1 Evidence and summary of findings

No systematic reviews addressing the efectiveness of antibiotics in children with non-severe pneumonia were identiied. However, two recent RCTs provide direct evidence. he evidence for the efectiveness of antibiotics is mixed, in part due to the signiicant but as yet undetermined proportion of children fulilling the criteria for non-severe pneumonia, who have either a viral illness or non-infectious aetiology. In Asia, up to 60 of children with non-severe pneumonia are reported to also have an audible wheeze by auscultation. Observational data provides evidence that: the addition of fever to the WHO cri- teria for pneumonia improves its speciicity for children with wheeze, and children with non-severe pneumonia and wheeze, with no fever or history of fever, have a low risk of bacterial pneumonia and most recover without antibiotics. here is also new evidence from one trial in Pakistan showing that antibiotics are no better than place- bo for children with WHO-deined non-severe pneumonia see GRADE table A7.8 . Antibiotics in all children presenting with non-severe pneumonia in Pakistan Hazir et al 2010 conducted a double-blinded, randomized, placebo-controlled trial of oral amoxicillin versus placebo for non-severe pneumonia in four centres in Pakistan. Children were enrolled if they fulilled WHO criteria for non-severe pneumonia: cough or diiculty breathing and fast breathing using age-dependant WHO cut-ofs. he study recruited 900 children, and randomized 450 children