title: Differences in evolution of children with non-severe acute lower respiratory tract infection with and without radiographically diagnosed pneumonia.
abstract: OBJECTIVE
  To identify differences in the evolution of children with non-severe acute lower respiratory tract infection between those with and without radiographically diagnosed pneumonia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A public university pediatric hospital in Salvador, Northeast Brazil.
  
  
  METHODS
  Children aged 2-59 months.
  
  
  METHODS
  By active surveillance, the pneumonia cases were prospectively identified in a 2-year period. Each case was followed-up for changes in various clinical symptoms and signs. Demographic, clinical and radiographic data were recorded in standardized forms. Exclusion was due to antibiotic use in the previous 48 hours, signs of severe disease, refusal to give informed consent, underlying chronic illness, hospitalization in the previous 7 days or amoxicillin allergy. Chest X-ray (CXR) was later read by at least 2 independent pediatric radiologists.
  
  
  METHODS
  Radiographic diagnosed pneumonia based on agreed detection of pulmonary infiltrate or pleural effusion in 2 assessments.
  
  
  RESULTS
  A total of 382 patients receiving amoxicillin were studied, of whom, 372 (97.4%) had concordant radiographic diagnosis which was pneumonia (52%), normal CXR (41%) and others (7%). By multivariate analysis, age (OR=1.03; 95% CI: 1.02-1.05), disease > 5 days (OR = 1.04; 95% CI: 1.001-1.08), reduced pulmonary expansion (OR = 3.3; 95% CI: 1.4-8.0), absence of wheezing (OR = 0.5; 95% CI: 0.3-0.9), crackles on admission (OR = 2.0; 95% CI: 1.2-3.5), inability to drink on day 1 (OR = 4.2; 95% CI: 1.05-17.3), consolidation percussion sign (OR = 7.0; 95% CI: 1.5-32.3), tachypnea (OR = 2.0; 95% CI: 1.09-3.6) and fever (OR = 3.6; 95% CI: 1.4-9.4) on day 2 were independently associated with pneumonia. The highest positive predictive value was at the 2nd day of evolution for tachypnea (71.0%) and fever (81.1%).
  
  
  CONCLUSIONS
  Persistence of fever or tachypnea up to the second day of amoxicillin treatment is predictive of radiographically diagnosed pneumonia among children with non-severe lower respiratory tract diseases.
authors.affiliation: Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil.
authors.forename: M-S H
authors.initials: MS
authors.lastname: Fontoura
authors.forename: A R
authors.initials: AR
authors.lastname: Matutino
authors.forename: C C
authors.initials: CC
authors.lastname: Silva
authors.forename: M C
authors.initials: MC
authors.lastname: Santana
authors.forename: M
authors.initials: M
authors.lastname: Nobre-Bastos
authors.forename: F
authors.initials: F
authors.lastname: Oliveira
authors.forename: B B
authors.initials: BB
authors.lastname: Barreto
authors.forename: C A
authors.initials: CA
authors.lastname: Araujo-Neto
authors.forename: S C
authors.initials: SC
authors.lastname: Andrade
authors.forename: R V
authors.initials: RV
authors.lastname: Brim
authors.forename: M-R A
authors.initials: MR
authors.lastname: Cardoso
authors.forename: C M
authors.initials: CM
authors.lastname: Nascimento-Carvalho
mesh_terms: D000208:Acute Disease; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin