International Journal of Clinical Case Reports 2024, Vol.14, No.3, 157-166 http://medscipublisher.com/index.php/ijccr 160 promise. A randomized, controlled trial in Tanzania found that a CRP-informed strategy combined with an electronic decision algorithm significantly reduced antibiotic prescription rates and improved clinical outcomes compared to the current WHO standard (Keitel et al., 2019). This approach highlights the potential of integrating biomarkers and decision-support tools to optimize treatment strategies and reduce antibiotic overuse. Additionally, ongoing research into RSV-specific treatments and vaccines aims to provide more targeted and effective therapies for children with ALRIs (Chaw et al., 2019b). 4 Evaluation of Treatment Outcomes 4.1 Clinical recovery and symptom resolution Clinical recovery and symptom resolution are critical indicators of treatment efficacy in children with acute lower respiratory infections (ALRIs). Studies have shown varying recovery times and symptom resolution rates depending on the type of infection and treatment administered. For instance, a study on children with pneumonia and bronchiolitis found that the length of hospital stay (LOS) was significantly different between the two conditions, with pneumonia cases having a longer LOS (5.8 ± 2.1 days) compared to bronchiolitis (3.2 ± 0.7 days) (Sultana et al., 2022). Additionally, the study highlighted that 89% of pneumonia cases and 100% of bronchiolitis cases showed clinical recovery, with bronchiolitis patients recovering faster from symptoms such as breathing difficulty and feeding issues (Sultana et al., 2022). In another study, the use of amoxicillin for uncomplicated lower respiratory tract infections (LRTIs) in children did not significantly reduce the duration of symptoms rated as moderately bad or worse compared to a placebo (Little et al., 2021). This suggests that antibiotics may not be necessary for uncomplicated cases, and clinicians should consider alternative management strategies. 4.2 Hospitalization rates and duration Hospitalization rates and the duration of hospital stays are important metrics for evaluating the burden of ALRIs on healthcare systems. Children with underlying conditions such as bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) are at a higher risk of severe ALRIs, leading to increased hospitalization rates and longer hospital stays. For example, children with BPD had a median LOS of 7.2 days compared to 2.5 days for those without BPD (Chaw et al., 2019b). Similarly, children with CHD had higher hospitalization rates and longer stays compared to those without CHD (Chaw et al., 2019a). A systematic review and meta-analysis identified several risk factors associated with prolonged hospital stays, including prematurity, young age, and the presence of comorbidities (Shi et al., 2021). These findings underscore the need for targeted interventions to reduce hospitalization rates and durations in high-risk populations. 4.3 Complications and adverse effects Complications and adverse effects are significant concerns in the treatment of ALRIs. The risk of complications such as the need for mechanical ventilation and intensive care unit (ICU) admission is higher in children with underlying conditions. For instance, children with BPD had higher odds of requiring mechanical ventilation (OR, 8.2) and ICU admission (OR, 2.9) compared to those without BPD (Chaw et al., 2019b). Similarly, children with CHD had higher risks of ICU admission and the need for supplemental oxygen therapy (Chaw et al., 2019a). The use of non-invasive ventilation (NIV) strategies such as continuous positive airway pressure (CPAP) and high flow nasal cannula (HFNC) has shown promise in reducing the need for intubation and treatment failure in children with ALRIs (Wang et al., 2021). However, there is still a lack of evidence showing significant benefits concerning mortality between different NIV interventions, indicating the need for further research. In terms of adverse effects, a study comparing delayed antibiotic prescription (DAP) to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) found that DAP reduced antibiotic use and gastrointestinal adverse effects without significantly affecting symptom duration or severity (Mas-Dalmau et al., 2021). This suggests that DAP could be a safer alternative to IAP in managing uncomplicated respiratory infections in children.
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