Redefining the World Health Organization algorithm for diagnosis of pneumonia with simple additional markers.

ABSTRACT

OBJECTIVES: WHO to examine the value of additional markers like history of previous respiratory distress and response to bronchodilator (BD) to redefine these guidelines. METHODS: Fifty (50) patients were analysed for presence of fever. Those who were febrile were put on antipyretic to look for resolution of tachypnea. Those who showed persistent tachypnea and those who were afebrile were analyzed for history of previous respiratory distress. Those who gave a positive history were challenged with BD. The association of persistent tachypnea and pulmonary infiltrates was recorded. RESULTS: Persistence of tachypnea after BD therapy was associated with pulmonary infiltrate in 7/8 (87.5%) whereas tachypnea persisted in 9/30 (30%) of those without infiltrates (p < 0.001). The proposed algorithm brings down the overuse of antibiotics from 78.9% to 26.3% (p <0.001) and also brings down the underuse of bronchodilators from 78.9% to 21.1 %(p<0.001). CONCLUSION: Adding simple markers like history of previous respiratory distress and response to BD therapy to the existing WHO guidelines it is possible to reliably differentiate pneumonia from acute exacerbation of asthma.