Community-acquired pneumonia among children: the latest evidence for an updated management

Nascimento‐Carvalho, Cristiana M.

doi:10.1016/j.jped.2019.08.003

Cited by 49 publications

(27 citation statements)

References 62 publications

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“…In the months from March to June, every year, a rise in respiratory diseases cause chaos in Brazilian hospitals, with crowded PICUs, with frequent need for new PICU temporary beds in previous years. The burden is high: in Brazil, during 2017, the most frequent causes of hospital admissions in the public health system of children under 5 years old were respiratory diseases (351,763, with 2,349 deaths—0.67%) ( 7 ). The peak of respiratory syncytial virus (RSV) infection, the most frequent cause of bronchiolitis, is in April and May, causing more hospitalizations and deaths in equatorial Brazil than influenza (including the 2009 pandemic) ( 8 , 9 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Novel Coronavirus on Brazilian PICUs

Araújo

Almeida²,

Lima‐Setta

et al. 2020

Pediatric Critical Care Medicine

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Objectives: To study the impact of the coronavirus disease 2019 pandemic, considering the physical distancing and schools closing, on the characteristics of admission and epidemiology on Brazilian PICUs. Design: Observational, multicenter, time series analysis, of electronic medical records from 15 PICU in Brazil. Data consisted of all March, April, and May PICU admissions from 2017 to 2020. Setting: Fifteen private PICUs in Brazil. Patients: Pediatric patients admitted to the PICU from March to May since 2017. Interventions: None. Measurements and Main Results: The period from March 11, 2020, to March 17, 2020, was considered the “intervention point” studied, corresponding to the suspension of school activities and the beginning of physical distancing in Brazil. During the pandemic period studied, there were 28 cases of coronavirus disease 2019 (one death). The mean age was higher ( p = 0.000), the length of stay was shorter ( p = 0.000), but mortality rates were similar among the periods ( p = 0.36). The model estimated a reduction of 1,483 PICU admissions from March 2020 to May 2020. At the end of May, there was an estimated drop of –146.6 bronchiolitis admissions (95% CI, –242.8 to –50.3; p = 0.016); –71 asthma admissions (95% CI, –93.6 to –48.63; p = 0.000); and –59 community-acquired pneumonia admissions (95% CI, –74.7 to –43.3; p = 0.000) per period. The model showed no effect of the “intervention” (physical distancing) on hospitalization rates for epilepsy, diarrhea, sepsis, bacterial meningitis, or surgery when analyzed individually. When assessed together, the model estimated a reduction of 73.6 admissions (95% IC, –132 to –15.2; p = 0.43). Conclusions: The coronavirus disease 2019 pandemic strongly affected Brazilian PICUs, reducing admissions, length of stay, and the epidemiological profile. The measures to oppose the coronavirus disease 2019 pandemic may have prevented thousands of PICU hospitalizations across the country.

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Section: Discussionmentioning

confidence: 99%

The Impact of the Novel Coronavirus on Brazilian PICUs

Araújo

Almeida²,

Lima‐Setta

et al. 2020

Pediatric Critical Care Medicine

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“…There have been several other studies that have shown the use of third-generation cephalosporins as the first-line treatment in pediatric CAP. Such broad-spectrum antibiotics have been shown to contribute to antimicrobial resistance and Clostridium difficile infection [17], and should be used judiciously only where there is a strong suspicion of highly penicillin-resistant Streptococcus pneumoniae or beta-lactamase producing Haemophilus influenzae [19]. Antibiotic use before the hospital admission was seen in 30% of the children in our study.…”

Section: Discussionmentioning

confidence: 61%

Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal

Pokhrel

Koirala

Gautam³

et al. 2021

TropicalMed

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In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted to a tertiary care public hospital in Nepal from 2017 to 2019. In this cross-sectional study involving secondary analysis of hospital data, there were 659 patients and 30% of them had a history of prehospital antibiotic use. Irrespective of prehospital antibiotic use, ampicillin monotherapy (70%) was the most common first-line treatment provided during hospitalization followed by ceftriaxone monotherapy (12%). The remaining children (18%) were treated with various other antibiotics alone or in combination as first-line treatment. Broad-spectrum antibiotics such as linezolid, vancomycin, and meropenem were used in less than 1% of patients. Overall, 66 (10%) children were required to switch to second-line treatment and only 7 (1%) children were required to switch to third-line treatment. Almost all (99%) children recovered without any sequelae. This study highlights the effectiveness of ampicillin monotherapy in the treatment of community-acquired pneumonia in hospitalized children in a non-intensive care unit setting.

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“…There are, however, risks and costs associated with intravenous use, and oral de-escalation is recommended as soon as feasible (evidence level IIIa). [102,103]…”

Section: Route Of Administrationmentioning

confidence: 99%

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Zar

Moore

Andronikou

et al. 2020

Afr J Thorac Crit Care Med

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Background. Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. Objective. To produce revised guidelines for pneumonia in South African children under 5 years of age. Methods. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. Recommendations. Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. Validation. The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

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Community-acquired pneumonia among children: the latest evidence for an updated management

Cited by 49 publications

References 62 publications

The Impact of the Novel Coronavirus on Brazilian PICUs

The Impact of the Novel Coronavirus on Brazilian PICUs

Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

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