Abstract
BackgroundThe aim of this study was to review the current status and usage of guidelines in the diagnosis and treatment of community-acquired pneumonia (CAP) in European countries and to compare to established guidelines in the United States (US), United Kingdom (UK), and the World Health Organization (WHO).MethodsA questionnaire was developed and distributed by the Community-Acquired Pneumonia Paediatric Research Initiative (CAP-PRI) working group and distributed to medical centres across Europe.ResultsOut of 19 European centres, 6 (31.6 %) used WHO guidelines (3 in combination with other guidelines), 5 (26.3 %) used national guidelines, and 5 (26.3 %) used local guidelines. Chest radiograph and complete blood count were the most common diagnostic examinations, while evaluation of clinical symptoms and laboratory tests varied significantly. Tachypnoea and chest recession were considered criteria for diagnosis in all three guidelines. In US and UK guidelines blood cultures, atypical bacterial and viral detection tests were recommended. In European centres in outpatient settings, amoxicillin was used in 16 (84 %) centers, clarithromycin in 9 (37 %) centers and azithromycin in 7 (47 %) centers, whereas in hospital settings antibiotic treatment varied widely. Amoxicillin is recommended as the first drug of choice for outpatient treatment in all guidelines.ConclusionsAlthough local variations in clinical criteria, laboratory tests, and antibiotic resistance rates may necessitate some differences in standard empirical antibiotic regimens, there is considerable scope for standardisation across European centres for the diagnosis and treatment of CAP.Electronic supplementary materialThe online version of this article (doi:10.1186/s41479-016-0005-y) contains supplementary material, which is available to authorized users.
Highlights
The aim of this study was to review the current status and usage of guidelines in the diagnosis and treatment of community-acquired pneumonia (CAP) in European countries and to compare to established guidelines in the United States (US), United Kingdom (UK), and the World Health Organization (WHO)
The aims of this study were to determine whether local guidelines for the diagnosis and treatment of CAP in children are available in European countries; to compare these guidelines and practices with regard to diagnosis and treatment; and to compare these local guidelines with published guidelines from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (PIDS-IDSA) [13], the British Thoracic Society (BTS) [1], and the WHO [15]
Three out of 19 (15.8 %) responding centres use WHO guidelines, 5 (26.3 %) centres use national guidelines, 5 (26.3 %) use guidelines approved by their hospital, 3 (15.8 %) centres use WHO and national guidelines, 2 (10.5 %) use other guidelines and 1 (5.3 %) centre did not use paediatric CAP guidelines (Fig. 1)
Summary
The aim of this study was to review the current status and usage of guidelines in the diagnosis and treatment of community-acquired pneumonia (CAP) in European countries and to compare to established guidelines in the United States (US), United Kingdom (UK), and the World Health Organization (WHO). In North America and Europe, the annual incidence of CAP was estimated to be approximately 34–40 cases per 1000 in children under 5 years of age [2], prior to widespread use of pneumococcal conjugate vaccines (PCVs). The distribution of causative agents of CAP varies with age, and respiratory virus infections are more common in early childhood [1, 8]. New guidelines from the United States (US) [1] and the United Kingdom (UK) [13] were published with specific recommendations regarding the diagnosis and treatment of CAP in children
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