Prediction of delayed recovery from pediatric community-acquired pneumonia

Aim of the present study was to evaluate the improvement of pediatric CAP, within 48 hours after starting therapy, in relation to age, etiology, clinical/laboratory characteristics and selected antibiotics.Ninety-four children were treated for radiologically confirmed CAP, 64 by oral amoxicillin, 23 by intravenous ampicillin and 7 by other antibiotics. The etiology of CAP was studied by serology, data on more than 20 clinical characteristics were collected retrospectively, and antibiotics were selected on clinical grounds.After starting of antibiotics, the mean duration of fever was higher in children ≥5 than <2 or 2-4 years of age (p = 0.003). Fever continued >48 hours in 4 (4.3%) children and 2 additional children had empyema. Clinical, radiological and laboratory characteristics and serological findings were not significantly associated with the duration of fever. Fever continued >24 hours in 1 (4.8%) child treated with ampicillin and in 2 (8%) inpatients compared with 19 (28.8%) children treated with amoxicillin (p = 0.007) and 23 (33%) outpatients (p = 0.0012), respectively.Respiratory rate and erythrocyte sedimentation rates were associated with rapid decrease of fever. Anyway, none of the reported characteristics was able to predict treatment failures or delayed fever decrease in children suffering from CAP.Streptococcus pneumoniae is the most common bacterial agent in pediatric community-acquired pneumonia (CAP) at any age, while Mycoplasma pneumoniae is more common among patients over 5 years of age [1]. The majority, over 90%, of basically healthy, western children with CAP clinically improve with disappearance of fever and reduction of breathing work within 48 hours after the onset of antibiotics, with no significant differences between beta-lactames and macrolides as first-line antibiotics [2-4]. In recent years, pneumococcal macrolide resistance has become an emerging problem [1], and complications such as empyema and even necrotizing pneumonia have bec