Evolution of acute infection with atypical bacteria in a prospective cohort of children with community-acquired pneumonia receiving amoxicillin

Nascimento‐Carvalho, Cristiana M.; Xavier-Souza, Gabriel; Vilas-Boas, Ana-Luisa; Fontoura, Maria-Socorro H; Barral, Aldina; Puolakkainen, Mirja; Ruuskanen, Olli

doi:10.1093/jac/dkx126

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…21 Foram também investigadas infecções bacterianas atípicas: a infecção aguda por M. pneumoniae foi diagnosticada pela detecção de anticorpos IgM específicos na amostra de soro convalescente, infecções agudas por Chlamydia pneumoniae e Chlamydia trachomatis foram diagnosticadas pela detecção de anticorpos IgM específicos ou mudanças significativas nos títulos de IgG ou IgA; foram diagnosticadas infecções agudas por M. pneumoniae (86/787; 10,9%), C. pneumoniae (79/733; 10,8%) e C. trachomatis (3/28; 10,7%) e 147 (20,1%), 731 pacientes investigados para essas três bactérias tinham infecção aguda por pelo menos uma dessas três bactérias (18 pacientes tinham testes concomitantemente positivos para infecção aguda por M. pneumoniae e C. pneumoniae). 22 Com base nos dados supracitados, é possível observar que os vírus respiratórios têm sido cada vez mais implicados na etiologia da PAC na infância, juntamente com o reconhecimento de que as infecções virais foram mais frequentes do que as bacterianas, mesmo em países em desenvolvimento.…”

Section: Etiologiaunclassified

“…Os autores concluíram que não era necessário tratar a infecção bacteriana atípica em todas as crianças entre 2-59 meses com PAC não grave; ao contrário, o uso de macrolídeos poderia ser reservado para aqueles casos raros em que a amoxicilina não era eficaz. 22 Uma outra questão prática é sobre a duração da terapia antibiótica. Uma revisão sistemática publicada em 2008 avaliou a eficácia de tratamentos curtos e longos do mesmo antibiótico, em crianças de 2-59 meses, com PAC não grave, e identificou dois ensaios clínicos nos quais três e cinco dias de tratamento com amoxicilina foram comparados (um na Índia e outro no Paquistão) e um ensaio clínico em que foram comparados três e cinco dias de Cotrimoxazol (na Indonésia e Bangladesh): nenhum estudo mostrou diferença na eficácia da duração do tratamento.…”

Section: Tratamentounclassified

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

Nascimento‐Carvalho¹

2020

Jornal de Pediatria

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Objective: To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature. Data source: A comprehensive search was conducted in PubMed, by using the expressionsAll articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading. Data synthesis: In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25 ng/dL was 92% (77---98%) and 93% (90---99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients. Conclusions: Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.

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Section: Etiologiaunclassified

Section: Tratamentounclassified

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

Nascimento‐Carvalho¹

2020

Jornal de Pediatria

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“…The overall substitution rate of amoxicillin was low, only 3.5%. 18 The results suggest that all children with non-severe CAP, who are younger than 5 years of age, can be treated with amoxicillin with no need to consider macrolides.…”

Section: At Ypic Al Pneumoniamentioning

confidence: 87%

“…In a study from Brazil, 787 patients aged 2-59 months with non-severe CAP received amoxicillin during a prospective survey. 18 Among them, 10.9% had serologic evidence of acute M. pneumoniae infection, however, without any association with the outcome at day five. The overall substitution rate of amoxicillin was low, only 3.5%.…”

Section: At Ypic Al Pneumoniamentioning

confidence: 93%

Antibiotic therapy in children with community‐acquired pneumonia

Korppi

2021

Acta Paediatrica

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British and American guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in children are 10 years old. The British Thoracic Society (BTS) updated the guidelines for the management of CAP in children in 2011, 1 and the Infectious Diseases Society of America (IDSA) and the Pediatric Infectious Diseases Society of America updated the guidelines for the management of CAP in infants and children older than 3 months likewise in 2011. 2 World Health Organization (WHO) revised the guidelines for classification and treatment of childhood pneumonia at health facilities in 2013. 3 The Finnish Current Care Guidelines for lower respiratory tract infections in children, including guidelines for paediatric CAP, were published in 2014 (available at www.kaypa hoito.fi).The aim of this mini-review was to update the available clinical data on antibiotic treatment of CAP in children aged more than 1 month. Pneumonia during the neonatal period, hospital-acquired pneumonia and pneumonia in children with an outstanding underlying illness or immunity-modifying treatment were out of scope of this review.

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“…CAP continues to be the leading cause of mortality in children under 5 years of age in low- and middle-income countries [ 5 ]. The most recently published studies have revealed that, in these children, CAP is caused by viruses (61–66%), bacteria (27%), atypical bacteria (7.2–20%), and Mycobacterium tuberculosis (M. tb) (2.9–5.9%) [ 6 , 7 , 8 , 9 , 10 ]. Furthermore, the coinfection of viruses and bacteria is not infrequent [ 6 , 7 , 8 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden

et al. 2022

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Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.

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Evolution of acute infection with atypical bacteria in a prospective cohort of children with community-acquired pneumonia receiving amoxicillin

Abstract: The overall substitution rate of amoxicillin was very low. It is not necessary to give an empirical non-β-lactam antibiotic as a first-line option to treat every child between 2 and 59 months old with non-severe CAP.

Cited by 9 publications

References 27 publications

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

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

Antibiotic therapy in children with community‐acquired pneumonia

Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden

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