Unsolved problems in the approach to pediatric community-acquired pneumonia.
ABSTRACT This review discusses unsolved problems concerning pediatric community-acquired pneumonia (CAP) and identifies the areas of research that need to be developed.
Diagnosing pediatric CAP and the required hospitalization are difficult problems especially in the presence of mild signs and symptoms. It is frequently not possible to identify the cause of this disease, and this explains why antibiotics are unnecessarily prescribed in some cases. The treatment recommendations for severe CAP are better defined than those for mild and moderate CAP.
It is possible to prepare recommendations for most of the problems that emerge in severe cases of pediatric CAP even though its cause can also be difficult to identify. However, the recommended approach to mild or moderate cases is always based on mainly moderate or poor quality evidence. There is an urgent need for further studies aimed at defining first-line and second-line antibiotic therapy for mild and moderate CAP. In the absence of new data, it is necessary to be aware that a substantial number of patients will not be optimally treated.
Article: Pneumonia.Pediatrics in Review 10/2013; 34(10):438-456. · 0.82 Impact Factor
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ABSTRACT: To critically summarise the available data on diagnosis of CAP in children, focusing on the newest findings and on the need for new studies. Eighty studies on the diagnosis of paediatric community-acquired pneumonia were scrutinised. We found no significant associations between the signs or symptoms and aetiology of pneumonia and concluded that chest radiographs remain controversial and real-time polymerase chain reaction appears more sensitive than blood cultures. Antibiotic overuse could make it difficult to differentiate viral and bacterial causes. Molecular methods provide promising tools for diagnosing infection by atypical bacteria, but are expensive and should be used selectively.Acta paediatrica (Oslo, Norway: 1992). Supplement 12/2013; 102(465):17-24.
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ABSTRACT: Community-acquired pneumonia (CAP) is a disease that frequently affects children and adults throughout the world. As it places a considerable burden on society and, particularly, healthcare resources, any means of reducing its incidence and impact arouses great interest. A substantial number of pediatric and adult CAP cases are due to Streptococcus pneumoniae but, fortunately, there are effective vaccines available that are likely to have a significant impact on CAP-related medical, social and economic problems. The main aim of this paper is to evaluate the published evidence concerning the impact of pneumococcal vaccines on CAP in children and adults. The original 7-valent pneumococcal conjugate vaccine (PCV-7) completely modified the total burden of pneumococcal diseases in vaccinated children and unvaccinated contacts of any age. However, the existence of some problems moderately reducing its preventive efficacy has led to the development of PCVs with a larger number of pneumococcal serotypes, including those that were previously of marginal importance but now cause of severe disease. It is reasonable to think that these PCVs (particularly PCV13, which includes all of the most important serotypes emerging since the introduction of PCV7) will further reduce the importance of pneumococcal diseases, although it is still not clear whether the replacement of the 23-valent polysaccharide vaccine with PCV13 would be more protective in adults.Pulmonary Pharmacology & Therapeutics 03/2014; · 2.54 Impact Factor