A PRACTICAL GUIDE FOR THE DIAGNOSIS AND TREATMENT OF PEDIATRIC PNEUMONIA

Objective: To develop guidelines for the diagnosis and management of c ommunity-acquired pediatric pneumonia. Options: Clinical assessment ra diography, laboratory testing, and empirical antimicrobial therapy. Ou tcomes: Increased awareness of age-related causes, improved accuracy o f clinical diagnosis, better utilization of diagnostic testing and the rational use of empirical antimicrobial therapy resulting in more rap id diagnosis, initiation of appropriate therapy and decreased morbidit y and mortality. Evidence: A MEDLINE search for relevant articles publ ished from 1966 to September 1996 using the MeSH terms ''pediatric,'' ''pneumonia,'' ''respiratory tract infection,'' ''pneumonitis,'' ''eti ology,'' ''diagnosis,'' ''therapy,'' ''antibiotics,'' ''resistance,'' ''radiology,'' ''microbiology'' and ''biochemistry.'' Values: A hierar chical evaluation of the strength of evidence modified from the method s of the Canadian Task Force on the Periodic Health Examination was us ed. When application of the hierarchy was not feasible or appropriate, different evaluation criteria were used. Benefits, harms and costs: I ncreased awareness of the causes of pneumonia, accurate diagnosis and prompt treatment should reduce costs associated with unnecessary inves tigations and complications due to inappropriate treatment. Recommenda tions: Age is the best predictor of the cause of pediatric pneumonia, viral pneumonia being most common during the first 2 years of life. Th e absence of a symptom cluster of respiratory distress, tachypnea, cra ckles and decreased breath sounds accurately excludes the presence of pneumonia (level II evidence). Bacterial cultures of samples from the nasopharynx and throat have no predictive value; however, Gram stainin g and culture of sputum from older children and adolescents are useful (level III evidence). Oral antimicrobial therapy will provide adequat e coverage for most mild to moderate forms of pneumonia in children (l evel III evidence). Parenteral therapy is typically reserved for neona tes and patients with severe pneumonia admitted to hospital (level III evidence). Validation: These recommendations are based on consensus o f Canadian experts in infectious diseases and microbiology. They are t he only guidelines to address antimicrobial treatment from an age-rela ted, etiologic perspective. Sponsor: The development of these guidelin es and the technical support and assistance of Core Health Inc. in pre paring this manuscript were funded through an unrestricted educational grant from Abbott Laboratories Canada. The sponsoring company was not involved in determining the membership of the consensus group or the content of the guidelines.