Article Text

AUDIT OF MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN CHILDREN IN A DISTRICT GENERAL HOSPITAL
  1. A A Chingale1,
  2. A C Smith1,
  3. K C Elias1,
  4. J D Gould1
  1. 1Department of Paediatrics, Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK

Abstract

Objective Community acquired pneumonia CAP is a common cause for hospitalisation in children. The British Thoracic Society BTS has published guidelines for management of CAP in children.

This audit was aimed at determining whether clinical diagnostic criteria, initial investigations, general management and antibiotic treatment of children presenting with CAP are in line with the British Thoracic Society BTS guidelines.

Methods Retrospective data were collected from the inpatient medical records of 20 children with a clinical diagnosis of CAP admitted to this District General Hospital over a sixmonth period.

Results Practices conforming to the BTS guidelines

1. The presenting clinical features were consistent with clinical diagnosis of CAP in all patients.

2. Hospitalisation criteria were based on hypoxia, poor intake andor dehydration, and severity of respiratory distress.

3. Amoxicillin was the most commonly used oral antibiotic. Macrolide antibiotics were used in all children aged above 5 years.

Practices not conforming to the BTS guidelines

1. Blood tests for acute phase reactants were performed in the majority of patients. Chest Xray was performed in all patients.

2. Nasopharyngeal aspirate for viral antigen detection was not consistently requested for children below the age of 18months.

3. Most antibiotics were initially administered via the intravenous route.

Conclusions 1. Oral antibiotics are safe and effective. Intravenous route should only be used when oral intake or absorption is a problem, or when the clinical course is complicated. 2. Most children with CAP can be managed in the community with appropriate advice and support to parents.

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