|
Indian Pediatr 2012;49:
363-369 |
|
Differences in Evolution of Children with
Non-severe Acute Lower Respiratory Tract Infection With and
Without Radiographically Diagnosed Pneumonia
|
M-SH Fontoura, AR Matutino, CC Silva, MC Santana, M Nobre-Bastos,
*F Oliveira,
BB Barreto, CA Araújo-Neto, $SC
Andrade, *RV Brim,
#M-R A Cardoso,
CM Nascimento-Carvalho and the PNEUMOPAC-Efficacy Study Group
From the Department of Pediatrics, Federal University
of Bahia School of Medicine, Salvador, Brazil; *Bahiana School of
Medicine, Bahiana Foundation for Science Development, Salvador, Brazil;
*Department of Image Diagnosis, Federal University of Bahia School of
Medicine, Salvador, Brazil; $Image Diagnosis Unit, Federal University of
Bahia Hospital, Salvador, Brazil; #Department of Epidemiology, Faculty
of Public Health, University of São Paulo, São Paulo, Brazil.
Correspondence to: CM Nascimento-Carvalho, Rua Prof
Aristides Novis, 105/1201B, Salvador, CEP 40210-630, Bahia, Brazil.
Email:
[email protected]
Received: February 6, 2011;
Initial review: March 14, 2011;
Accepted: August 02, 2011.
Published online: 2011, October 30.
PII: S0974755911000108-1
|
Objective: To identify differences in the evolution of children with
non-severe acute lower respiratory tract infection between those with
and without radiographically diagnosed pneumonia.
Design: Prospective cohort study.
Setting: A public university pediatric hospital
in Salvador, Northeast Brazil.
Patients: Children aged 2-59 months.
Methods: By active surveillance, the pneumonia
cases were prospectively identified in a 2-year period. Each case was
followed-up for changes in various clinical symptoms and signs.
Demographic, clinical and radiographic data were recorded in
standardized forms. Exclusion was due to antibiotic use in the previous
48 hours, signs of severe disease, refusal to give informed consent,
underlying chronic illness, hospitalization in the previous 7 days or
amoxicillin allergy. Chest X-ray (CXR) was later read by at least
2 independent pediatric radiologists.
Main Outcome Measures: Radiographic diagnosed
pneumonia based on agreed detection of pulmonary infiltrate or pleural
effusion in 2 assessments.
Results: A total of 382 patients receiving
amoxicillin were studied, of whom, 372 (97.4%) had concordant
radiographic diagnosis which was pneumonia (52%), normal CXR (41%) and
others (7%). By multivariate analysis, age (OR=1.03; 95% CI: 1.02-1.05),
disease ≥ 5days (OR = 1.04; 95% CI:
1.001-1.08), reduced pulmonary expansion (OR = 3.3; 95% CI: 1.4-8.0),
absence of wheezing (OR = 0.5; 95% CI: 0.3-0.9), crackles on admission
(OR = 2.0; 95% CI: 1.2-3.5), inability to drink on day 1 (OR = 4.2; 95%
CI: 1.05-17.3), consolidation percussion sign (OR = 7.0; 95% CI:
1.5-32.3), tachypnea (OR = 2.0; 95% CI: 1.09-3.6) and fever (OR = 3.6;
95% CI: 1.4-9.4) on day 2 were independently associated with pneumonia.
The highest positive predictive value was at the 2nd day of evolution
for tachypnea (71.0%) and fever (81.1%).
Conclusion: Persistence of fever or tachypnea up
to the second day of amoxicillin treatment is predictive of
radiographically diagnosed pneumonia among children with non-severe
lower respiratory tract diseases.
Key words: Acute respiratory infection, Children, Fever, Lower
respiratory tract disease, Lung disease, Respiratory discomfort.
|
Pneumonia has been identified
as a leading killer of children in developing countries and a cause of
significant morbidity worldwide [1]. In order to control childhood
deaths in resource poor settings, the World Health Organization (WHO)
proposed the use of a standardized management based on the detection of
simple signs in the 1990s [2]. Such approach and its improvements were
assessed taking into account clinical and chest X-ray (CXR)
findings on admission [3]. The major difficulty in diagnosing pneumonia
promptly, particularly in first-level health care settings, is the
absence of an easily feasible and definitive gold-standard diagnostic
criteria [4]. In the emergency room (ER), it is mandatory to distinguish
between children with and without pneumonia and the CXR evaluation is a
fundamental tool for accomplishing this goal [5]. To the best of our
knowledge, clinical aspects of the evolution of clinical symptoms and
signs in children with and without radiographically diagnosed non-severe
pneumonia remains poorly described.
In this study, we aimed to identify differences in
evolution of children with non-severe acute lower respiratory tract
infection between those with and without radiographically diagnosed
pneumonia receiving amoxicillin. The results on clinical failure are
presented elsewhere [6].
Methods
Participants: Children aged between 2 and 59
months seen in the ER of Professor Hosannah de Oliveira Pediatric Center,
in Salvador, North-east Brazil, from November 2006 to October 2008, who
underwent CXR for suspicion of pneumonia were prospectively identified.
The study protocol was approved by the Ethics Committee of the Federal
University of Bahia. For recruitment purpose, pneumonia was defined as
report of respiratory complaints and detection of lower respiratory
tract findings plus presence of pulmonary infiltrate on CXR taken on
admission and read by the pediatrician on duty. Children were
excluded if there were lower chest indrawing, danger signs (inability to
drink, convulsions, somnolence, central cyanosis, grunting in a calm
child), underlying chronic diseases (anatomic abnormalities of the
respiratory tract, chronic pulmonary illness besides asthma,
immunological defects, progressing neurological disorders, psychomotor
retardation, heart disease with clinical repercussion, hemoglobinopathy,
liver or kidney disease), severe malnutrition, other concurrent
infection, hospitalization during the previous 7 days, amoxicillin or
similar antibiotic use during the last 48 hours, allergy to amoxicillin
or history of aspiration. Nutritional evaluation was performed by using
the software "Anthro" (WHO) and severe malnutrition was defined as
Z-score for weight-for-age under -3.00. Written informed consent was
obtained from parents or legal guardians before enrolment. One trained
medical student from the research team was in the study setting every
morning and afternoon. A thorough examination was performed and data on
demographics, clinical history, and physical examination were recorded
at admission. The child’s respiratory rate was assessed by observing the
thorax for 60 seconds when the child was awake, calm and without fever;
if the child presented with fever, an antipyretic was given and the
temperature was lowered before the respiratory rate was assessed. Fever
was defined as axillary temperature >37.5º C [7], and tachypnea as
respiratory rate ³50
breaths/min in children aged 2-11 months and
³40 breaths/min in
children from 12 months of age onwards [8].
Amoxicillin was given at a daily dosage 50 mg/kg.
Evolution follow-up: Patients were evaluated in
the hospital twice a day, for up to 5 days and a senior pediatrician
personally checked each evaluation. The patients stayed in the
observation ward for children without signs of severity with their
respective caregiver so that they could be carefully followed-up by the
research team, who also assisted the drug administration. Amoxicillin
for up to the tenth day of treatment and the telephone number of the
surveillance coordinator were supplied to the guardian adult at
discharge and a phone call was advised if the patient developed any new
complaint. Each child was discharged from hospital when there was no
more fever and respiratory discomfort. At the fifth day of treatment, a
telephone call was made to the caregiver to enquire for symptoms and
interventions. Cure was recorded when the caregiver informed of absence
of all the presenting symptoms. A follow-up examination was performed 2
to 4 weeks after recruitment. Every patient received a telephone call on
the day before the scheduled outpatient visit to remind them. All
clinical data were collected without knowledge about the final CXR
assessment.
Radiological studies: For the purpose of this
study, CXR were read by two pediatric radiologists who were unaware of
the patients’ clinical history and evolution. Each pediatric radiologist
gave his assessment independently. In case of disagreement regarding
diagnosis of pneumonia, CXR was read by a third pediatric radiologist
without knowledge on the previous evaluations. Radiographic findings
were recorded in a standardized form according to previously published
recommendation [9]. The pediatric radiologist looked for the presence of
pulmonary infiltrate, consolidation, pleural effusion, atelectasis,
hyperinflation, abscess, peribronchial thickening, pneumatocele and
pneumo-thorax. The pulmonary infiltrate was characterized as alveolar,
interstitial or alveolar-interstitial. Pneumonia was radiographically
diagnosed if there was agreement on presence of pulmonary infiltrate or
pleural effusion in 2 independent assessments.
Data management and analysis: Epi-Info (version
6.04) was used for data entry, Statistical Package for the Social
Sciences (SPSS 9.0) and STATA (version 9.0) were used for statistical
analysis. The presence of a symptom or sign at least once during the two
daily evaluations was considered as presence of that finding on that day
of evolution. Differences in proportions were assessed by using the
Pearson chi square or Fisher’s exact tests and continuous variable by
the Student t or Mann-Whitney U tests, as appropriate. Bivariate and
multivariate analyses, using logistic regression models, were performed
to identify association between radiographically diagnosed pneumonia on
admission and findings during evolution. The 95% confidence intervals
were calculated. Sensitivity, specificity and predictive values were
calculated. The positive and negative likelihood ratio (LR) were
estimated. The study protocol was approved by the Ethics Committee of
the Federal University of Bahia.
Results
Overall, 630 patients were evaluated, out of whom 239
were excluded [antibiotic use in the previous 48 hours (n=95),
signs of severe disease (n=92), refusal to give informed consent
(n=18), underlying chronic illness (n=17), hospitalization
in the previous 7 days (n=10) or amoxicillin allergy (n=7)].
Moreover, 6 families refused to continue in the study, 3 children had
poor quality on CXR at the evaluation of the first 2 pediatric
radiologists and there was no agreement between 2 of 3 participant
radiologists in the reading of CXR of 10 patients. Therefore, the study
group included 372 patients.
The median (Inter quartile range, IQR) age was 26
(13-40) months. Seventy five (20.2%) children were younger than 1 year.
There were 201 (54.0%) males and 14 (3.8%) malnourished patients. The
median (IQR) duration of disease was 6 (4-10) days and the most frequent
complaints were cough (98.7%), fever (94.1%), difficulty breathing
(68.8%), vomiting (47.6%) and wheezing (29.8%). Rales (70.7%), crackles
(62.4%), tachypnea (50.8%) and fever (36.3%) were the most common
findings. None presented with cyanosis, abdominal distension or stridor.
Only 5 (1.3%) patients presented with chest retraction, but nobody
showed lower chest indrawing.
Agreement was found between the first 2 pediatric
radiologists in 284 (74.3%) cases. By adding the evaluation from the
third pediatric radiologist, agreement was found in 372 (97.4%) cases.
The final radiographic diagnosis was pneumonia (n = 192; 51.6%),
normal CXR (n = 152; 40.9%) and other diagnosis (n = 28;
7.5%) which comprised peribronchial thickening (2.9%), atelectasis
(2.4%), hyperinflation (1.6%), peribronchial thickening plus atelectasis
(0.3%) or plus hyperinflation (0.3%). Abscess, pneumatocele and
pneumothorax were not described. Table I shows the
comparison of baseline characteristics according to the radiographic
diagnosis subgroup.
Table I Baseline Characteristics According to Radiographic Diagnosis
Characteristic |
Pneumonia
(n = 192) |
Normal CXR
(n = 152) |
Other diagnosis
(n = 28) |
P value# |
History |
Age (mo)* |
32 (17-45) |
22 (12-36) |
19 (10-29) |
<0.001 |
Duration of disease (d)* |
7 (4-10) |
5 (4- 8) |
5 (3-8) |
0.01 |
Duration of fever (d)* |
4 (2.5-7) |
3 (2-5) |
3 (2-5) |
0.03 |
Age ≥1 year |
164 (85.4) |
115 (75.7) |
18 (64.3) |
0.02 |
Disease ≥5 days |
141 (73.4) |
96 (63.2) |
18 (64.3) |
0.04 |
Male sex |
106 (55.2) |
79 (52.0) |
16 (57.1) |
0.6 |
Malnutrition |
5 (2.6) |
7 (4.6) |
2 (7.1) |
0.3 |
Cough |
189 (98.4) |
151 (99.3) |
27 (96.4) |
1.0 |
Fever |
187 (97.4) |
138 (90.8) |
25 (89.3) |
0.008 |
Difficulty breathing |
132 (68.8) |
102 (67.1) |
22 (78.6) |
0.7 |
Vomiting |
88 (45.8) |
79 (52.0) |
10 (35.7) |
0.3 |
Wheezing |
57 (29.7) |
49 (32.2) |
5 (17.9) |
0.6 |
Physical examination |
Fever |
76 (39.6) |
50 (32.9) |
9 (32.1) |
0.2 |
Tachypnea |
104 (54.2) |
69 (45.4) |
16 (57.1) |
0.1 |
Irritability |
11 (5.7) |
18 (11.8) |
1 (3.6) |
0.04 |
Chest retraction |
5 (2.6) |
0 |
0 |
0.07 |
Prolonged expiration |
22 (11.5) |
26 (17.1) |
9 (32.1) |
0.1 |
Reduced pulmonary expansion |
42 (21.9) |
9 (5.9) |
1 (3.6) |
<0.001 |
Rales |
130 (67.7) |
114 (75.0) |
19 (67.9) |
0.1 |
Wheezing |
46 (24.0) |
54 (35.5) |
12 (42.9) |
0.02 |
Crackles |
126 (65.6) |
83 (54.6) |
23 (82.1) |
0.04 |
Tubal murmur |
4 (2.1) |
0 |
1 (3.6) |
0.1 |
Hepatomegaly |
7 (3.6) |
1 (0.7) |
0 |
0.08 |
Splenomegaly |
2 (1.0) |
0 |
0 |
0.5 |
CXR-Chest X-ray; * Results are reported as median (IQR),
Other results are reported in n (%); #Pneumonia vs Normal CXR. |
Among 344 patients with pneumonia or normal CXR, 337
(98.0%) were hospitalized. The median (25th-75th percentile) duration of
hospitalization was 1 day (1-2, range 1-21 days). Amoxicillin was
substituted with another antibiotic in 12 (3.2%) inpatients at the first
(n=1), second (n=2), third (n=5), fourth (n=2)
or fifth (n=2) day of treatment because of clinical deterioration
(n=5), concurrent infection (sinusitis or otitis) diagnosed
during follow-up (n=3), persistent vomiting (n=2),
persistence of symptoms (n=1) or immediate allergic reaction (n=1).
All patients were discharged after improvement. Table II
presents the significant differences on evolution in a univariate
analysis and Table III depicts the significant differences
on admission or evolution in a multivariate analysis between children
with radiographic diagnosis of pneumonia and normal CXR on admission.
Table IV shows the validation of tachypnea and documented
fever on admission and up to the second day of evolution. The positive
LR of tachypnea or fever on the second day of evolution was 1.88 (95%
CI: 1.27-2.78) and 3.29 (95% CI: 1.49-7.28), respectively. On the
contrary, the negative LR of both characteristics was 0.80 (95% CI:
0.70-0.88) and 0.88 (95% CI: 0.81-0.94), respectively.
Table II Differences in Evolution Between Children with Pneumonia and Normal Chest Radiograph on Admission
Characteristic |
Pneumonia |
Normal CXR |
P |
|
(n=192) |
(n=152) |
value |
Inability to drink$ |
13 (6.8) |
3 (2.0) |
0.04 |
Percussion sign of consolidation* on |
Day 1 |
29 (15.1) |
2 (1.3) |
<0.001 |
Day 2 |
24 (12.6) |
2 (1.4) |
<0.001 |
Day 3 |
15 (22.1) |
0 |
0.002 |
Tachypnea on |
Day 1 |
112 (58.3) |
72 (47.4) |
0.04 |
Day 2 |
66 (34.7) |
27 (18.5) |
0.001 |
Fever on |
Day 1 |
108 (56.3) |
62 (40.8) |
0.004 |
Day 2 |
30 (15.8) |
7 (4.8) |
0.001 |
Hospital length† (d) |
1 (1-2) |
1 (1-1) |
0.02 |
CXR indicates chest x-ray. Day 1 is the first day after
staying over 1 night in the hospital, day 2 is the second day
after staying over 2 nights in the hospital, and so on. The
number of hospitalized patients with pneumonia on day 1,2 or 3
was 192, 190 and 68, respectively. The number of hospitalized
patients with normal CXR on day 1, 2 or 3 was 152, 146 and 32,
respectively. Results are reported in n (%) Except †
Results are reported as median ( IQR); $on Day 1. |
Table III Multivariate Analysis of Clinical Findings on Admission or Evolution Between Children with
Pneumonia or Normal Chest Radiograph on Admission (N=336)*
|
OR (95% CI) |
Characteristic |
Unadjusted |
Adjusted |
On admission |
Age |
1.03 (1.01-1.04) |
1.03 (1.02-1.05) |
Disease ≥5 days |
1.03 (1.00-1.07) |
1.04 (1.001-1.08) |
Reduced pulmonary expansion |
4.4 (2.1-9.5) |
3.3 (1.40-7.98) |
Wheezing |
0.57 (0.36-0.91) |
0.53 (0.30-0.94) |
Crackles |
1.59 (1.03-2.46) |
2.01 (1.17-3.46) |
On evolution |
|
|
On Day 1 |
Inability to drink |
3.61 (1.01-12.90) |
4.25 (1.05-17.26) |
On Day 2 |
Consolidation percussion sign |
10.41 (2.42-44.80) |
7.05 (1.54-32.34) |
Tachypnea |
2.35 (1.40-3.92) |
1.97 (1.09-3.58) |
Fever |
3.72 (1.58-8.74) |
3.59 (1.37-9.40) |
Day 1 is the first day after staying over 1 night in the
hospital, day 2 is the second day after staying over 2 nights in
the hospital. *8 children had been discharged on the first
day. |
Table IV Validation of Tachypnea and Documented Fever on Admission and Up to Second Day
of Evolution for the Diagnosis Of Pneumonia
Characteristics |
Sensitivity |
Specificity |
Positive |
Negative |
|
|
|
Predictive |
Predictiv |
|
|
|
Value % |
Value % |
Tachypnea |
On admission |
54.2 |
54.6 |
60.1 |
48.5 |
On Day 1 |
58.3 |
52.6 |
60.9 |
50.0 |
On Day 2 |
34.7 |
81.5 |
71.0 |
49.0 |
Fever |
On admission |
39.6 |
67.1 |
60.3 |
46.8 |
On Day 1 |
56.2 |
59.2 |
63.5 |
51.7 |
On Day 2 |
15.8 |
95.2 |
81.1 |
46.5 |
Day 1 is the first day after staying over 1 night in the
hospital, day 2 is the second day after staying over 2 nights in
the hospital. |
Successful telephonic contact, between the fourth and
seventh day of treatment (median=5 days, IQR = 5-5 days), was obtained
with 336 (98.2%) families who informed that the child had complete
resolution of symptoms (75.2%), improvement with persistence of at least
one initial complaint (24.2%), absence of improvement (n = 1;
0.3%) or worsening (n = 1; 0.3%). At this moment, report of
complete resolution of symptoms was more frequent among those with
normal CXR (80.7% vs. 70.7%; P = 0.04). Ambulatory
follow-up evaluation occurred between 11 and 38 days after recruitment
(median 21; IQR= 17-23) among 337 (98.0%) patients; mean duration of
amoxicillin administration was 10 ± 1 day among 323 users. No clinical
difference at this time was found by comparing patients with pneumonia
or normal CXR (data not shown).
Discussion
We observed differences among simple signs like
tachypnea and fever during the evolution, specifically on the second
day, between children aged 2-59 months with and without radiologically
diagnosed pneumonia. Although the implementation of the standardized
management for children with respiratory complaints recommended by WHO
has resulted in decreased childhood mortality in developing countries
[10], the recognition that the proposed diagnostic criteria by WHO, that
is, cough or difficulty breathing plus tachypnea [8],
are not always sensitive indicator of pneumonia
has been published [11]. In a clinical trial of different doses of
amoxicillin in the treatment of non-severe pneumonia conducted in
Pakistan, children were included by applying WHO criteria and out of 891
cases only 6.8% had radiographic pneumonia [12]. In the 1990s, several
studies examined the validity of the WHO guidelines for diagnosing
pneumonia in children under 5 years of age and the presented sensitivity
range between 59-81% [13-17]. In these investigations, children with
radiographic pneumonia were compared with those with upper respiratory
tract infection.
The necessity to improve WHO case management of
childhood pneumonia especially due to the clinical overlap of pneumonia
with other lower respiratory tract diseases has been reported [18]. In
this study, the inclusion criteria comprised subjects aged 2-59 months
who underwent CXR for suspicion of pneumonia after undergoing a clinical
examination by the pediatrician on duty in the emergency room (ER). By
using this strategy, children with a clinical diagnosis of lower
respiratory tract infection compromising were selected while there was
no association of tachypnea at admission with radiographic pneumonia
there was an association of radiographic pneumonia with older age (for
each additional month on age the risk for pneumonia increases 3%) with
absence of wheezing. These findings might be explained by the overlap on
clinical presentation of children with bronchiolitis and pneumonia:
bronchiolitis predominates in children under 12 months of age and
presents with fast breathing and wheeze [19]. By calculating the
validity of simple signs independently associated with radiographic
pneumonia, the highest positive predictive value was at the 2 nd
day of evolution for tachypnea (71.0%) and fever (81.1%). Another
Brazilian investigation recently showed that the addition of fever to
cough and tachypnea on admission greatly enhances the ability to
identify pneumonia cases among children with different lower respiratory
tract diseases [20]. From the results presented herein, it is possible
to observe that persistence of fever or tachypnea on the second day of
treatment enhances the chance of children with acute lower respiratory
tract disease to have radiographically diagnosed pneumonia (that is, the
positive LR X the Adjusted odd ratio).
The frequency of reported cure was significantly
higher on the fifth day telephone call survey for those with normal CXR
on admission. This suggests that the resolution of the clinical findings
of patients with radiographic pneumonia is slower than that among
children with other lower respiratory tract diseases. Although this
result might have been expected, it raises worry about the length of
antibiotic administration to treat pneumonia. The WHO has recommended
antibiotic use for 3-5 days to children with non-severe pneumonia [21],
and this recommendation comes from studies in which children were
included by using WHO diagnostic criteria [22,23]. A recent
meta-analysis recognizes that more well-designed randomized clinical
trials are needed to support such recommendation [24]; we now add
addition evidence. We did not investigate the etiology and this is a
limitation. However, this study was carried out in a scenario that is
similar to many ERs, all over the world. In this study, the duration of
amoxicillin administration was 10 days to be in accordance with the
national Brazilian guidelines, for ethical reason [25].
In this investigation, the final radiographic
diagnosis was based on the agreement of 2 independent assessments by
trained pediatric radiologists using a standard evaluation form
previously validated [9]. The use of such strict criteria was meant to
control the subjective bias that may occur in CXR reading [4]. In
addition to that, the close evaluation on admission and evolution by a
senior pediatrician, the low rate of loss to follow-up and the
implementation in only one pediatric center contribute to the
reliability of our results.
To conclude, this study, to the best of our
knowledge, is the first prospective study enrolling and following
children with non-severe CAP treated with amoxicillin, where detailed
clinical and radiographic aspects on admission and evolution were
registered. From our data, persistence of fever or tachypnea up to the
second day of amoxicillin treatment is predictive of radiographically
diagnosed pneumonia among children with non-severe lower respiratory
tract diseases.
Acknowledgments: The authors are thankful to the
pediatricians and nurses of the Professor Hosannah de Oliveira Pediatric
Center, Federal University of Bahia, Salvador, Brazil. Maria-Regina A
Cardoso and Cristiana M Nascimento-Carvalho are investigators of the
Brazilian Council for Science and Technology Development (CNPq).
Contributors: M-SHF, ARM, CCS, MCS, MNB, FO, BBB,
and the PNEUMOPAC-Efficacy Study Group collected the clinical data and
drafted the manuscript; CAAN, SCA and RVB read the chest X-rays,
filled the radiographic forms out, took part in the interpretation of
the results and criticized the manuscript; M-RA Cardoso took part in the
analysis and revised the manuscript; CMNC conceived the research
question and designed the study protocol, analyzed the data and revised
critically the manuscript. All authors approved the submitted version.
Funding: This research was funded by the the
Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB), Salvador,
Brazil. Maria-Regina A Cardoso and Cristiana M Nascimento-Carvalho are
investigators of the Brazilian Council for Science and Technology
Development (CNPq). Neither FAPESB nor CNPq had any role in handling or
completing the research. The authors had full control of all primary
data.
Competing interests: None stated.
Appendix I
PNEUMOPAC-Efficacy Study Group Phase I (in
alphabetical order):
D A Braga1, G Xavier-Souza1, G V Nogueira1, I
Lorgetto2, Í S Oliveira1, I N Costa2, J Araripe2, J R Vieira2, L B
Neiva1, L Noblat, PhD3, P M Santos, BS3, S F Câmara1, S Carneiro, BS3, U
R Sirmos1, V F Araújo1
1Department of Pediatrics, Federal University of
Bahia School of Medicine, Salvador, Brazil.
2Bahiana School of Medicine, Bahiana Foundation for
Science Development, Salvador, Brazil.
3 Pharmacy Unit, Federal University of Bahia
Hospital, Salvador, Brazil.
|
What is Already Known?
• WHO criteria to diagnose pneumonia in
children (cough or difficulty breathing plus tachypnea) are
sensitive to identify pneumonia cases among children with upper
respiratory infection. The criteria are not sensitive to
distinguish pneumonia from other lower respiratory tract
infections.
What This Study Adds?
• Persistence of fever or tachypnea up to the
second day of amoxicillin treatment is predictive of
radiographically diagnosed pneumonia among children with
non-severe lower respiratory tract infections.
|
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