Management Of Pediatric Pneumonia Research Articles

Breaking down resistance: Verapamil analogues augment the efficacy of antibiotics against Streptococcuspneumoniae via MATE transporter interference

Pneumonia, an infectious lung disease, is a significant global health concern, claiming the lives of 740,180 children in 2019, which accounts for 14 % of pediatric deaths. Recently, the management of pediatric pneumonia has become complex due to exposure to indoor and outdoor environmental toxins. Notably, exposure to pollutants and antibiotic-resistant bacteria during community and hospital-acquired pneumonia poses a serious threat to patient outcomes. The development of antibiotic resistance against Streptococcuspneumoniae is driven by the DinF efflux pump protein, which expels antibiotics from bacterial cells, leading to multidrug resistance. Therefore, blocking DinF could serve as a strategy to combat antibiotic resistance. This study aimed to identify DinF inhibitors from compounds analogous to verapamil, a well-known DinF inhibitor, through computational techniques including molecular docking, molecular dynamics simulations, ADMET analysis, MMGBSA, quantum mechanics, and Network Pharmacology. After considering docking scores, results of MMGBSA, quantum mechanics, Molecular Dynamics Simulations, ADMET analysis and network pharmacology profiling four compounds namely netarsudil, rimegepant, GSK-1521498 and tariquidar were found as the most promising DinF inhibitors. Therefore, these compounds hold a great promise as leads to the development of potent DinF inhibitors; however, further studies are needed to warrant their clinical uses against antibiotic resistant Streptococcuspneumoniae-induced pneumonia.

Management of Pediatric Pneumonia: A Decade After the Pediatric Infectious Diseases Society and Infectious Diseases Society of America Guideline.

Incomplete uptake of guidelines can lead to nonstandardized care, increased expenditures, and adverse clinical outcomes. The objective of this study was to evaluate the impact of the 2011 Pediatric Infectious Diseases Society and Infectious Diseases Society of America (PIDS/IDSA) pediatric community-acquired pneumonia (CAP) guideline that emphasized aminopenicillin use and de-emphasized the use of chest radiographs (CXRs) in certain populations. This quasi-experimental study queried a national administrative database of children's hospitals to identify children aged 3 months-18 years with CAP who visited 1 of 28 participating hospitals from 2009 to 2021. PIDS/IDSA pediatric CAP guideline recommendations regarding antibiotic therapy, diagnostic testing, and imaging were evaluated. Segmented regression interrupted time series was used to measure guideline-concordant practices with interruptions for guideline publication and the Coronavirus Disease 2019 (COVID-19) pandemic. Of 315 384 children with CAP, 71 804 (22.8%) were hospitalized. Among hospitalized children, there was a decrease in blood culture performance (0.5% per quarter) and increase in aminopenicillin prescribing (1.1% per quarter). Among children discharged from the emergency department (ED), there was an increase in aminopenicillin prescription (0.45% per quarter), whereas the rate of obtaining CXRs declined (0.12% per quarter). However, use of CXRs rebounded during the COVID-19 pandemic (increase of 1.56% per quarter). Hospital length of stay, ED revisit rates, and hospital readmission rates remained stable. Guideline publication was associated with an increase of aminopenicillin prescribing. However, rates of diagnostic testing did not materially change, suggesting the need to consider implementation strategies to meaningfully change clinical practice for children with CAP.

A Quality Improvement Project for the Management of Pediatric Pneumonia with Effusion at the Montreal Children’s Hospital: Comparison of Video-Assisted Thorascopic Surgery and Chest Tube Thoracostomy with Outcomes

A Quality Improvement Project for the Management of Pediatric Pneumonia with Effusion at the Montreal Children’s Hospital: Comparison of Video-Assisted Thorascopic Surgery and Chest Tube Thoracostomy with Outcomes

Variations in the management of pneumonia in pediatric emergency departments: compliance with the guidelines

We sought to assess compliance with evidence-based guidelines for the management of pediatric pneumonia, including the variations in tests ordered and antimicrobials prescribed. Our primary hypothesis was that compliance with the treatment recommendations from the most current guidelines would be low for antimicrobial prescriptions. We conducted a chart review at the Children's Hospital in London, Ont., to assess variation in the management of pediatric pneumonia. All patients aged 3 months to 18 years seen at the pediatric emergency department between Apr. 1, 2006, and Mar. 31, 2007, with a diagnosis of pneumonia were eligible for inclusion in the study. Compliance with management guidelines was 59.7% (95% confidence interval [CI] 53%-66%, n = 211) in children 5-18 years old and 83.0% (95% CI 80%-86%, n = 605) in children 3 months to 5 years old. Significant variation existed in the choice of antimicrobial agent for children with pneumonia, with nonrecommended agents frequently prescribed. Significant variation existed in the management of pediatric pneumonia, and adherence to guidelines was low for the group of patients aged 5-18 years. Future studies should attempt to provide guidance to distinguish between viral and bacterial etiology to allow judicious use of antimicrobials.

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Guidelines for the management of paediatric pneumonia

Guidelines for the management of paediatric pneumonia

Parenteral-Oral Switch in the Management of Paediatric Pneumonia

In phase I of a 2-phase study, 56 evaluable children (0.8 to 5 years) with lobar or segmental pneumonia received intravenous or intramuscular ceftriaxone 50 mg/kg/day for 2 days followed by oral cefetamet pivoxil 20 mg/kg/day in 2 divided doses to complete 7 days of treatment. All patients achieved a clinical cure. In phase II, a randomised open multicentre study, 62 children with pneumonia received an identical regimen to phase I (arm A), and 59 children received ceftriaxone 50 mg/kg/day for 1 day followed by 6 days' treatment with cefetamet pivoxil 20 mg/kg/day (arm B). Patients from phase I and arm A were combined giving a total of 118 evaluable patients in arm A. At the end of treatment, 100% of patients in arm A and 96% in arm B achieved a clinical cure; cure was maintained in 99 and 98% of patients, respectively. Two (4%) patients in arm B failed therapy; in both cases, factors other than treatment failure may have accounted for the poor response. 11 and 12% of patients in treatment arms A and B, respectively, experienced adverse events; gastrointestinal events (nausea and/or vomiting) were reported in 9 and 8% of patients, respectively. In conclusion, 1 or 2 days' treatment with parenteral ceftriaxone before switching to oral cefetamet pivoxil was safe and effective in the treatment of childhood pneumonia. Therefore, parenteral-oral switch is a feasible treatment option in the treatment of serious paediatric community-acquired pneumonia.