Diagnosis and management of community-acquired pneumonia in childhood - South African thoracic society guidelines

Background. Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence, severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective. To develop guidelines for the diagnosis, management and prevention of CAP in South African children. Methods. The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence, expert opinion was accepted. After peer review and revision, the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations. Recommendations based on epidemiological factors include a diagnostic approach, investigations, supportive therapy, appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation. These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in paediatrics, paediatric pulmonology, radiology, infectious diseases and microbiology. Published international guidelines have also been consulted.