EM:RAP Emergency Medicine: Reviews and Perspectives

Thank you, Dr Claudius for summarizing the 44 page document on treatment of Pediatric Pneumonia. Unfortunately the recomendations from the ID societies sounded more opinion based rather than evidence based. I think the problems starts with the question "what is the gold standard for defining pediatric pnemonia?" Is it on the basis of signs/symptoms, chest radiograph, nested Polymerase Chain Reaction (PCR), procalcitonin (PCT), CRP, latex agglutination, immunochromatographic membrane assay, or lung aspirate? Studies that have tried to look at that issue identify that there is a lack of a gold standard definition. Clearly if someone has a well defined infiltrate on CXR and signs and sxs then most would agree that is a pneumonia. But what about the kid with URI type signs and sxs who has a possible infiltrate on CXR? Is that a pneumonia? So we have a disease that is ill defined in a pediatric population. We compound this problem by the fact most mild cases of pneumonia are thought to be viral and get better on their own. So it would be very difficult to design an outcome based study to find out which antibiotic is best for outpatient pneumonia. The study conclusion might be " We gave antibiotics x,y, or z and no matter what we gave they still seemed to get better on their own" So at least on outpatient basis we're not really sure what a pneumonia is and we're not really sure how to treat it.
Oh well, thanks for summarizing the 44 page document.

pen allergic you would give levofloxacin over Azithromycin? Isn't there a concern with Quinolones in kids when you have other agents?