The influence of modern microbiological methods on the antibiotic treatment of pneumonia in children

Abstract

Background: Treatment of community acquired pneumonia (CAP) in children depends on the etiology, which is not easy to determine in this age group. Although viruses represent common cause of CAP in preschool children, the vast majority of children are still treated with antibiotics. Modern diagnostic methods for detection of viruses and atypical bacteria can help to determine the etiology. We hypothesized that this method influences the antibiotic treatment of CAP in hospitalised children. Methods: We performed a prospective study of 130 hospitalized children with CAP. Naso-pharyngeal swab was taken for detection of respiratory viruses and atypical bacteria with PCR based diagnostics. Empirical antibiotic therapy was recorded on the first 24 hours of the admission and on a third day of hospitalization, when the results of microbiological investigations were available. Results: On the first day, antibiotic treatment was prescribed in 115 (88.5%) of subjects. 61.7% of them were treated with penicillin-based antibiotic, 16.9% with a macrolide and 12.2% with a combination of penicillin and macrolide. On a third day of hospitalisation 114 (87.7%) of subjects were still treated with an antibiotic. Percentage of those treated with a macrolide increased to 24.3% and those treated with a combination decreased to 6.1%. Conclusions: The results of microbiological investigations did not reduce the proportion of children, treated with antibiotics. However, they influenced the adjustment of therapy, especially in children with atypical bacterial pneumonia. In most children with deteced viral infection, we did not abolish the antibiotic therapy as bacterial superinfection could not be excluded.