Prediction of delayed recovery from pediatric community-acquired pneumonia

BACKGROUND: If children with community-acquired pneumonia (CAP) do not recover within 48 hours after starting antibiotic therapy, complications are possible and a checkup must be ensured. 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.