Fever and tachypnea strong indicators of pneumonia in children with lower respiratory tract infections

India leads the world in childhood pneumonia incidence, with 43 million new cases per year, as estimated by the World Health Organization (WHO). Pneumonia can be difficult to diagnose, especially in patients with lower respiratory complaints in settings where chest x-ray (CXR) testing is not available. Knowing the signs and symptoms that point to pneumonia in children with lower respiratory illnesses can help physicians correctly diagnose and treat pneumonia.

Key Point: India has the highest rate of childhood pneumonia in the world. A recent study found that the strongest predictors of radiographically diagnosed pneumonia in children with lower respiratory infections were the persistence of fever and tachypnea up to the second day of amoxicillin treatment.

In a recent study in Brazil, researchers performed a prospective cohort study to compare cases of nonsevere acute lower respiratory tract infection with and without radiographically diagnosed pneumonia. In total, 372 patients aged 2 months to 59 months with lower respiratory complaints were followed in the study. Each child underwent a clinical evaluation by a pediatrician and received a CXR upon admission.

Symptoms were recorded throughout the study period, and a 10-day course of[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] amoxicillin was provided to all patients. All data were collected without the providers’ knowledge of CXR findings.

In total, 52% of the children were found to have pneumonia, 41% had normal CXR findings, and 7% were found to have another diagnosis. Among all symptoms, those with the highest predictive value for pneumonia were:

  • the persistence of fever, defined as an axillary temperature of 37.5° Celsius or higher, on the second day of treatment;
  • the persistence of tachypnea, defined as a respiratory rate of 50 or more breaths/minute in children aged 2 months to 11 months, and 40 or more breaths/minute in older children, also on the second day of amoxicillin treatment.

On the fifth day of treatment, investigators telephoned patients’ families to ask if symptoms had resolved. The frequency of reported cures was higher among patients with normal CXR findings than among those with pneumonia on day 5.

The authors suggest that future studies should consider extending the WHO’s recommendation for a 3- to 5-day course of antibiotics for pneumonia.

Sources: Fontoura MS, Matutino AR, Silva CC, et al for The PNEUMOPAC-Efficacy Study Group. Differences in evolution of children with non-severe acute lower respiratory tract infection with and without radiographically diagnosed pneumonia. Indian Pediatr. 2012;49(5):363-369.

Rudan I, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization. 2008;86(5):408-416. Available at: http://www.who.int/bulletin/volumes/86/5/07-048769-table-T2.html.

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