Abstract
Mortality and morbidity remain high in pediatric lower respiratory tract infections (LRTIs) despite progress in research and implementation of global diagnostic and treatment strategies in the last decade. Still, 120 million annual episodes of pneumonia affect children younger than 5 years each year leading to 1.3 million fatalities with the major burden of disease carried by low- and middle-income countries (95%). The definition of pneumonia is still challenging. Traditional diagnostic measures (i.e., chest radiographs, C-reactive protein) are unable to distinguish viral and from bacterial etiology. As a result, common antibiotic overuse contributes to growing antibiotic resistance. We present an overview of current evidence from observational and randomized controlled trials on a procalcitonin (PCT)-based diagnosis of pediatric LRTIs and discuss the need for an adequate PCT threshold for antibiotic treatment decision-making.
Highlights
We present an overview of current evidence from observational and randomized controlled trials on a procalcitonin (PCT)-based diagnosis of pediatric lower respiratory tract infections (LRTIs) and discuss the need for an adequate PCT threshold for antibiotic treatment decision-making
Over the past 15 years, pediatric evidence emerged for PCT as a useful diagnostic component for antibiotic treatment decisions in febrile LRTI and for other infectious diseases such as sepsis, meningitis, and urinary tract infections
Feasibility and safety of PCT antibiotic guidance were proven for adult thresholds used in children and adolescents with LRTIs irrespective of other diagnostic tests
Summary
Reliable differentiation between uncomplicated and self-limiting acute respiratory tract infections and more severe disease requiring antibiotic treatment remains challenging. Bacterial pneumonia in need of antibiotic treatment may complicate viral respiratory tract infection. Biomarkers of inflammation and radiologic imaging have not been reliable so far in differentiating viral from bacterial infections and are not available in every medical setting. Only non-specific clinical parameters (tachypnea, chest indrawing in mild and moderate cases, reduced fluid uptake, and/or reduced consciousness in very severe cases) with questionable ability to distinguish viral from bacterial LRTI, and no diagnostic tests are included in the WHO definition of childhood pneumonia and in the British Thoracic Society guidelines for the management of uncomplicated pediatric pneumonia [16, 17]. The resulting antibiotic overtreatment of pediatric chest infections [20, 21] has to be seen critically in the light of increasing antibiotic consumption and resistance rates [22]
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