Children with pneumonia: how do they present and how are they managed?

Abstract

Objective: To describe the spectrum of clinical features and management of community acquired pneumonia in the UK. Design: Prospectively recorded clinical details for all children with possible pneumonia and chest x ray (CXR) changes in 13 hospitals in the North of England between 2001 and 2002. Results: 89% of 711 children presenting to hospital with pneumonia were admitted; 96% received antibiotics, 70% intravenously. 20% had lobar CXR changes, 3% empyema and 4% required intensive care. Respiratory rate (RR), hypoxia and dyspnoea all correlated with each other and prompted appropriate interventions. Admission in children, not infants, was independently associated with RR, oxygen saturation, lobar CXR changes and pyrexia. Neither C-reactive protein, lobar CXR changes or pyrexia were associated with severity. Children over 1 year old with perihilar CXR changes more often had severe disease (p = 0.001). Initial intravenous antibiotics were associated with lobar CXR changes in infants and children and with dyspnoea, pyrexia and pleural effusion in children. The presence of pleural effusion increased duration of antibiotic treatment (p,0.001). Cefuroxime was the most often used intravenous antibiotic in 61%. Oral antibiotics included a penicillin in 258 (46%), a macrolide in 192 (34%) and a cephalosporin in 117 (21%). Infants stayed significantly longer (p,0.001) as did children with severe disease (p,0.01), effusions (p = 0.005) or lobar CXR changes (p(0.001).Conclusions: There is a high rate of intravenous antibiotic administration in hospital admissions for pneumonia. Despite lobar CXR changes not being independently associated with severe disease, initial lobar CXR changes and clinical assessment in children independently influenced management decisions, including admission and route of antibiotics.

Oral versus i.v. antibiotics for community-acquired pneumonia in children: a cost-minimisation analysis

“…Attempts were also undertaken to quantify potential cost savings and the budgetary impact of alternative treatment regimes, using the findings of two epidemiological papers [5,22]. A study of 13 hospitals in the north-east of England over a period of 12 months found that 711 children with pneumonia presented to a paediatrician and 89% were admitted [22].…”

“…A study of 13 hospitals in the north-east of England over a period of 12 months found that 711 children with pneumonia presented to a paediatrician and 89% were admitted [22]. The authors further found that 501 children were given i.v.…”

Why do children hospitalised with pneumonia not receive antibiotics in primary care?

“…Antibiotics are recommended as first-line treatment for community-acquired pneumonia and are almost always prescribed to preschool aged children on hospital admission with pneumonia 1 2. For example, the British Thoracic Society recommends amoxicillin as first-line treatment for children <5 years old with community-acquired pneumonia 3.…”

“…It reported that only 22% of infants and 31% of children 1–15 years old had received antibiotics before admission 1. Moreover, the children not prescribed antibiotics had more severe disease on hospital admission 1.…”

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

“…1 There is ongoing research into the diagnostic value of vital signs in children in primary care settings, 2 however evidence from ambulatory settings has identified signs such as RR as useful in tools in assessing children with serious infections. [3][4][5][6][7] Many such studies have been conducted in populations where the risk of serious infection is much higher (for example, emergency departments) than typically found in UK general practice.…”