Jadavji T, Law B, Lebel M H, Kennedy W A, Gold R, Wang E E
Pediatric Residency Program, Alberta Children's Hospital, Toronto, Ont.
CMAJ. 1997 Mar 1;156(5):S703-11.
To develop guidelines for the diagnosis and management of community-acquired pediatric pneumonia.
Clinical assessment, radiography, laboratory testing, and empirical antimicrobial therapy.
Increased awareness of age-related causes, improved accuracy of clinical diagnosis, better utilization of diagnostic testing and the rational use of empirical antimicrobial therapy resulting in more rapid diagnosis, initiation of appropriate therapy and decreased morbidity and mortality.
A MEDLINE search for relevant articles published from 1996 to September 1996 using the MeSH terms "pediatric," "pneumonia," "respiratory tract infection," "pneumonitis," "etiology," "diagnosis," "therapy," "antibiotics," "resistance," "radiology," "microbiology" and "biochemistry."
A hierarchical evaluation of the strength of evidence modified from the methods of the Canadian Task Force on the Periodic Health Examination was used. When application of the hierarchy was not feasible or appropriate, different evaluation criteria were used.
BENEFITS, HARMS AND COSTS: Increased awareness of the causes of pneumonia, accurate diagnosis and prompt treatment should reduce costs associated with unnecessary investigations and complications due to inappropriate treatment.
Age is the best predictor of the cause of pediatric pneumonia, viral pneumonia being most common during the first 2 years of life. The absence of a symptom cluster of respiratory distress, tachypnea, crackles and decreased breath sounds accurately excludes the presence of pneumonia (level II evidence). Bacterial cultures of samples from the nasopharynx and throat have no predictive value; however, Gram staining and culture of sputum from older children and adolescents are useful (level III evidence). Oral antimicrobial therapy will provide adequate coverage for most mild to moderate forms of pneumonia in children (level III evidence). Parenteral therapy is typically reserved for neonates and patients with severe pneumonia admitted to hospital (level III evidence).
These recommendations are based on consensus of Canadian experts in infectious diseases and microbiology. They are the only guidelines to address antimicrobial treatment from an age-related, etiologic perspective.
The development of these guidelines and the technical support and assistance of Core Health Inc. in preparing this manuscript were funded through an unrestricted educational grant from Abbott Laboratories Canada. The sponsoring company was not involved in determining the membership of the consensus group or the content of the guidelines.
制定社区获得性小儿肺炎的诊断和管理指南。
临床评估、影像学检查、实验室检测及经验性抗菌治疗。
提高对与年龄相关病因的认识，提高临床诊断的准确性，更好地利用诊断检测手段并合理使用经验性抗菌治疗，从而实现更快速的诊断、开始适当治疗并降低发病率和死亡率。
使用医学主题词“儿科”“肺炎”“呼吸道感染”“肺炎”“病因学”“诊断”“治疗”“抗生素”“耐药性”“放射学”“微生物学”和“生物化学”对1996年至1996年9月发表的相关文章进行医学文献数据库检索。
采用了根据加拿大定期健康检查特别工作组方法修改的证据强度分级评估。当分级应用不可行或不恰当时，使用不同的评估标准。
益处、危害和成本：提高对肺炎病因的认识、准确诊断和及时治疗应降低与不必要检查及不适当治疗引起的并发症相关的成本。
年龄是小儿肺炎病因的最佳预测指标，病毒性肺炎在生命的头两年最为常见。不存在呼吸窘迫、呼吸急促、啰音和呼吸音减弱的症状群可准确排除肺炎的存在（二级证据）。鼻咽和咽喉样本的细菌培养无预测价值；然而，大龄儿童和青少年痰液的革兰氏染色和培养是有用的（三级证据）。口服抗菌治疗可为大多数儿童轻度至中度肺炎提供充分的覆盖（三级证据）。肠外治疗通常仅用于新生儿和住院的重症肺炎患者（三级证据）。
这些建议基于加拿大传染病和微生物学专家的共识。它们是从与年龄相关的病因学角度处理抗菌治疗的唯一指南。
这些指南的制定以及Core Health Inc.在撰写本手稿时提供的技术支持和协助由加拿大雅培实验室的无限制教育赠款资助。赞助公司未参与确定共识小组的成员或指南的内容。
