Arch Dis Child 2000;83:320-324 ( October )

Article

Rationalised prescribing for community acquired pneumonia: a closed loop audit Helena Clements^a, Terence Stephenson^a, Vanessa Gabriel^a, Timothy Harrison^b, Michael Millar^d, Alan Smyth^c, William Tong^e, Chris J Linton^d

^a Academic Division of Child Health, University Hospital, Nottingham NG7 2UH, UK, ^b Central Public Health Laboratory Service, 61 Colindale Avenue, London NW9 5HT, UK, ^c Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK, ^d Department of Microbiology, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK, ^e Department of Medical Microbiology, Royal Liverpool Hospital, Duncan Building, Liverpool L7 8XW, UK

Correspondence to: Prof. Stephenson email: Terence.Stephenson{at}nottingham.ac.uk

Accepted 1 June 2000

AIMSTo audit the management of community acquired pneumonia before and after the introduction of a protocol. To determine the aetiology of pneumonia using routine investigations and polymerase chain reaction (PCR).
METHODSRetrospective and prospective audit following the introduction of a management protocol. Prospective cases were investigated routinely and with PCR on blood and nasopharyngeal aspirate.
RESULTSThere was a significant increase in rational prescribing following introduction of the protocol with 75% of children receiving intravenous penicillin or erythromycin compared with 26% beforehand. Of 89 children in the prospective group, 51 microbiological diagnoses were achieved in 48 children. Seven children had Streptococcus pneumoniae infection, 14 had Mycoplasma infection, six had pertussis, and one had Chlamydia pneumoniae infection. Twenty three children had a viral cause of which respiratory syncytial virus was commonest.
CONCLUSIONSIntroduction of the protocol led to improved prescribing. PCR increased the diagnostic yield and the results support the management protocol.


Keywords: community acquired pneumonia; polymerase chain reaction; antibiotics; rationalised prescribing

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© 2000 by Archives of Disease in Childhood
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