Office pediatrics: current perspectives on the outpatient evaluation and management of lower respiratory infections in children.
OBJECTIVE
The outpatient evaluation and management of a child with lower respiratory infection (LRI) remain a challenge to clinicians worldwide. This update will discuss current problems and new developments in the outpatient evaluation and treatment of pediatric LRIs.


RESULTS
The cause of pediatric LRIs remains partially defined. Mixed infections and 'unknown' organisms may be important sources of clinical illness. A wider incidence of atypical bacteria LRIs (notably Mycoplasma pneumoniae) in children is now recognized. Viral LRIs from rhinoviruses and human metapneumovirus are increasingly detected in children. Human metapneumovirus may compound the clinical severity of pediatric LRIs, specifically in combination with respiratory syncytial virus. Innovations in testing for viral LRIs offer a promising tool for the outpatient evaluation and management of pediatric LRIs.


CONCLUSIONS
Neither clinical symptoms nor findings on chest radiographs can reliably distinguish children with bacterial LRIs from those with viral or atypical pathogens. The efficacy of outpatient antibiotic treatment of atypical bacteria LRIs remains unproven. Multiplex rapid viral testing may ultimately help to refine strategies for outpatient management. The outpatient treatment of viral LRIs remains limited to supportive care; the 'value' of bronchodilators, epinephrine, or corticosteroids for treatment of bronchiolitis is unconfirmed.
Long Island Jewish Medical Center, Schneider Children's Hospital, Department of Emergency Medicine, Albert Einstein College of Medicine, New Hyde Park, New York, USA. kligflom@comcast.net
Jean E
JE
Klig
D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D006801:Humans; D011859:Radiography; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents