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Article: New Pneumonia Guidelines
Written by: Mark Gettleman, M.D., F.A.A.P.
“What do you mean she has pneumonia? I was just at my doctor’s office and they said it was viral!” you hear yourself say.
“Well, both the X ray and blood work shows it. We’ll give her a shot of antibiotics and some to take at home,” the Emergency Room doctor replies.
Have you experienced this frustrating scenario? How could this be missed? Chances are it wasn’t. There has always been ambiguity on how to diagnose and treat pneumonia in children. The good news is that newly published guidelines by the Pediatric Infectious Diseases Society should resolve some of these discrepancies. The following is a review of the 52 page report which pertains to outpatient treatment of pneumonia.
Diagnosis: The diagnosis should be made based on the exam, not tests. While this may be counterintuitive, the science supports these findings. Blood tests, including CBCs do not add helpful information.
According to these guidelines even X-rays are not necessary. The studies show that the evaluation of the X-rays is subjective. So there is variation even among experts on diagnosing pneumonia. Also, X-rays cannot distinguish viral from bacterial cause. Therefore, they do not have a substantial impact on clinical outcomes. Up to 19% of kids had occult pneumonia, which is an X-ray sign of pneumonia without actually having the disease or needing to be treated. It is even more difficult in a wheezing child. Only 4.9% of children who were wheezing had pneumonia, and without having a fever this number goes down to 2%, so 98% did not have pneumonia.
The only test which should be done at certain times is to look for influenza. If the flu virus is present, it greatly diminishes the chance of a bacterial infection, so instead of an antibiotic, an antiviral could be used.
Treatment: Antimicrobial therapy is not routinely required because viruses are responsible for the great majority of disease. That’s right; the guidelines say with a strong recommendation based on the highest quality of evidence they have, that your child does not automatically need antibiotics for pneumonia. In young children with a viral pneumonia, antibiotics not only will not help but may cause unwanted side effects, toxicity and bacterial resistance. When an antibiotic is used, the one that should work best with the least number of unwanted effects is Amoxicillin. (Although for some older kids, Zithromax is appropriate.)
You are now armed with knowledge, which a lot of doctors don’t have. As much as this advice may be counter-intuitive, and as much as you may want to give your child something to get them better, not succumbing to societal pressure to treat, may actually keep your kids healthier in the long run.