MANAGEMENT OF PNEUMONIA
IN CHILDREN
Schinaki A, Tsilimingaki
A, Tsekoura T, Zampetakis G, Tsourounakis N, Apostolou E, Stefanaki S
Pediatric
Department, Venizelio Hospital, Heraklion Crete, Greece
Pneumonia is a common
illness in childhood that necessitates hospital admission in several cases
Objective: The
aim of the study was to investigate the possible etiologic factor and
prognosis of pneumonia according to intial x-ray findings and laboratory
tests in order to determine the appropriate antibiotic treatment.
Methods:
Ninety-six children (age: 1 month; 14 years old, mean age: 4.3 yrs), with
low respiratory tract infection that were admitted to our department from
1.1.1999 until 31.12.2000, were studied retrospectively. There were 50 boys
(52%) and 46 girls (48%). Routine laboratory tests during admission
included chest x-ray, White Blood Count (WBC), ESR, CRP, 2 blood specimens
for culture, and viral and bacteria serology tests. Patients were divided
in two groups according to chest x ray findings.
Results: The
first group included 74 children (mean age 6.8 yrs) with alveoral
infiltrates in chest x-ray, WBC> 15.000/ml in 89%, ESR>30mm in 74%,
CRP>20mg/lt in 72%. Antibiotic treatment was applied for 5 to 18 days
(mean duration: 8.5 days). Penicillin was administered in 38% of children,
Ampicilline/Sulbactam or Amoxycilline/Clavulanate in 35%, Makrolides in
20%, 2nd and 3rd generation cephalosporines in 20%, Clyndamycin in 9.5% and
Vancomycin in 7% of patients. Strept. Pneumoniae (succeptible to penicilline)
was isolated in the blood culture in 8% of children. Pleural effusion was
present in 6.5%. The second group included 22 children (mean age 2.5 years)
with interstitial infiltrates, WBC> 15.000/ml in 67%, ESR>30mm in
50%, CRP>20mg/lt in 36%. Antibiotic treatment was applied for 1-10 days
(mean duration 4.5 days). Ampicilline/Sulbactam or Amoxycilline/Clavulanate
in 41%, Makrolides in 18%, 2nd and 3rd generation cephalosporines in 13%
and 28%(infants < 12 months old) respectively. None of the patients
developed a positive blood culture. During discharge definitive improvement
of chest x-ray findings was observed in 65% of group A and 87% of group B
patients. At 6 weeks follow up absolute resolution of pneumonia was
observed in 93% and 98% respectively.
Conclusions: The age, chest x-ray
finding, inflammatory factors and clinical presentation during admission
may predict the etiology of pneumonia. The decision of appropriate
antimicrobial treatment if necessary remains empirical. The serology and
viral immunofluorescence may increase the diagnostic yield if available.
From the results of the present study it is evident that viral or mixed
etiology pneumonias occur in younger age groups that necessitate shorter
hospitalization and develop earlier resolution of x-ray findings.