J Pediatr Infect Dis 2018; 13(01): 057-062
DOI: 10.1055/s-0037-1607266
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in Nepal

Dhruba Shrestha
Department of Pediatrics, Siddhi Memorial Hospital, Bhaktapur, Nepal
Dybesh Regmi
Department of Family Medicine, UAE University, Al Ain, United Arab Emirates
Ganendra Raya
Department of Pediatrics, Siddhi Memorial Hospital, Bhaktapur, Nepal
Amar Prajapati
Department of Pediatrics, Siddhi Memorial Hospital, Bhaktapur, Nepal
Suruchi Dhaubhadel
Department of Nursing Siddhi Memorial Hospital, Bhaktapur, Nepal
Sushmita Puri
Department of Nursing Siddhi Memorial Hospital, Bhaktapur, Nepal
› Author Affiliations
Funding None.
Further Information

Publication History

19 April 2017

07 September 2017

Publication Date:
11 December 2017 (eFirst)


Background The massive burden of pediatric pneumonia is associated with high morbidity and mortality, particularly in developing countries where immunization programs are absent or recently been implemented. The objective of this study was to describe the number of hospitalizations and outcomes of children aged 1 month to 10 years with community-acquired pneumonia (CAP) between January 1, 2014, and June 30, 2015, in semi-rural Nepal.

Methods This retrospective study was undertaken prior to the implementation of the pneumococcal conjugate vaccination (PCV) program in Bhaktapur district of Nepal. Chart review of children with CAP, defined as the presence of symptoms, physical examination findings compatible with bacterial pneumonia together with lobar consolidation on chest X-ray (CXR), was performed. Data extracted included laboratory parameters and blood cultures on admission, antibiotic treatment, and length of hospital stay, as well as complications, such as death, intensive care unit admission, pleural effusion, and empyema. Outcomes assessed were clinical improvement accompanied by radiological improvement of consolidation.

Results During the study period, 367 patients were admitted with pneumonia, of which, 74 (20%) had definite CXR evidence of lobar pneumonia. A total of 86.5% of the cases were children < 5 years of age. Admission blood cultures from all patients were negative. More than 80% of patients had white blood cell (WBC) counts >11,000/mm3 and ≥ 75% neutrophils. The highest number of cases presented between February and July. Forty-three of 45 patients responded to crystalline penicillin (CP), and 25/27 patients treated with cefotaxime also responded; the mean duration of treatment was 10 ± 2.3 days. There were no deaths. None of the patients developed empyema, sepsis, or pleural effusion or required intensive care unit admission.

Conclusions CAP in pre-PCV semi-rural Nepal mostly affects male children < 5 years old and peaks between March and May. In-hospital treatment with CP or cefotaxime is effective.