Standard case management of pneumonia in hospitalized children in Uruguay,1997 to 1998

Objective. To report the results of the use of antimicrobial guidelines for the management of children with community-acquired bacterial pneumonia. Methods. Admittance and discharge criteria and algorithms for diagnosis and treatment were established. The decision to treat with antibiotics was bas ed on radiologic findings in pneumonia with pulmonary consolidation and lef t to the attending physician's criteria in the remaining cases. The use of antibiotics was limited to penicillin and derivatives (ampicillin, amoxicil lin) and macrolides. Results. Of the 1163 children treated as bacterial pneumonia, hospitalized in public and private health facilities in Montevideo from September, 1997, through September, 1998, standard case management was applied in 1082 (93% ). Age distribution was: <1 month, 1%; between 1 and 11 months, 29%; betwee n 1 and 5 years, 50%; >5 years, 20%. Chest radiography showed evidence of p ulmonary consolidation in 843 children (73%). Bacteria were detected in blo od culture and/or pleural fluid of 57 children (5%). In 51 the identified m icroorganism was Streptococcus pneumoniae, susceptible to penicillin in 30, intermediate in 6 and resistant in 5 (maximum MIC, 4 mug/ml); in 10 cases etiologic diagnosis was made by antigen detection. Empyema was present in 6 2 children (5.3%); 38 (3.27%) required treatment in an intensive care unit; and 5 (0.4%) died. Conclusions. Compliance with standard case management was highly satisfacto ry. Outcome of children treated with penicillin and derivatives was good, i ncluding children with empyema and pneumatocele and two patients with penic illin-resistant S. pneumoniae. At the present time S. pneumoniae resistant to penicillin is not an important problem in children with pneumonia in Uru guay. Surveillance of identified microorganisms and their antimicrobial sus ceptibility must continue.