PII: S0196-0644(99)70332-X

Abstract

We agree with Dr Baraff’s comment that radiographic pneumonia may be of viral origin; however, a recent article by Heiskanen-Kosma et al 1 Heiskanen-Kosma T Korppi M Jokinen C et al. Pediatr Infect Dis J. 1998; 17: 986-991 Crossref PubMed Scopus (300) Google Scholar found serologic evidence of bacterial infection in 51% of pediatric pneumonias. Additionally, we concur with Dr Baraff’s statement that patients in this select population of young, highly febrile children with leukocytosis probably do have bacterial infection. In reference to Dr. Baraff’s comment about avoiding unnecessary diagnostic studies in children who would already be treated (empirically) for occult bacteremia, he ignores 3 issues: (1) empiric treatment of those at risk for occult bacteremia is not universally accepted, (2) the duration of antibiotic treatment prescribed for those at risk for bacteremia is brief and has never been shown to be sufficient for eradication of bacterial pneumonia, and (3) establishing the diagnosis of pneumonia may be valuable for follow-up care. Although we support empiric antibiotic treatment in those identified to be at risk for occult bacteremia, we hope that the presence of high fever and leukocytosis will alert physicians to consider bacterial foci that might be missed by examination alone.