British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011

Procalcitonin and community-acquired pneumonia (CAP) in children

“…The European and American guidelines [21][22] recommend beta lactam treatment as the first choice in hospitalized children of all ages, to target Streptococcus pneumoniae. In 95% of children with bacterial pneumococcal CAP, apyrexia is reached within 48 h of antibiotic treatment.…”

Guidelines helping clinicians make the GRADE

“…Dr. Jake looks at the British Thoracic Society guidelines, and notices that they recommend a course of antibiotics for all children with a clear clinical diagnosis of pneumonia, stating that bacterial and viral pneumonias cannot be differentiated reliably. [17] The only available information available to Jake about the development of that recommendation is that it was a formal combination of expert views [17]. Jake would have loved to hear more from the guideline developers on this issue, but since no further information was readily available, he turned to the Infectious Diseases Society of America (IDSA) guideline, and saw a recommendation that preschool-age children with CAP not receive antibiotics, as viral pathogens cause the vast majority of CAPs in that population [18].…”

What are evidence‐based guidelines and what are they not?

“…The diagnosis and treatment of paediatric laryngitis and infant pertussis are well established in the current medical literature. Likewise, there is good agreement about how to diagnose and treat CAP in Western children, although the clinical diagnosis of pneumonia is difficult and microbe-specific diagnosis is seldom possible (4,5). However, the systematic reviews and meta-analyses on paediatric pneumonia, which have been published by the Cochrane Library, reflect the situation in developing countries and are not suitable for implementation in European countries (6).…”