Aim To evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals.
Methods A nationwide survey of all university hospitals (n = 35) took place in 2011 to assess practices for children with parapneumonic effusion, through a hypothetical clinical vignette and a standardized questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results, additional treatment, and action in the absence of improvement. Answers of paediatricians working in emergency departments, intensive care units, and conventional paediatric units were compared.
Results Of the 100 paediatricians contacted, 95 responded: 98% would order an initial blood test, and 70% diagnostic thoracentesis. All would start immediate antibiotic therapy: 31% with a single drug, 67% with 2 drugs, and 2% with 3 drugs. The most frequent initial choices were third-generation cephalosporin alone (17%) or combined with rifampicin (33%) or vancomycin (24%). Adaptation varied according to drug used, dose, and duration, especially when the microorganism was not S. pneumoniae. Practices did not differ significantly among the different groups of paediatricians.
Conclusion Standardized management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.
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