title: Changing clinical practice: management of paediatric community-acquired pneumonia.
abstract: OBJECTIVE
  To compare clinical features and management of paediatric community-acquired pneumonia (PCAP) following the publication of UK pneumonia guidelines in 2002 with data from a similar survey at the same hospitals in 2001-2002 (pre-guidelines).
  
  
  METHODS
  A prospective survey of 11 hospitals in Northern England was undertaken during 2008-2009. Clinical and laboratory data were recorded on children aged ≤16 years who presented with clinical and radiological features of pneumonia.
  
  
  RESULTS
  542 children were included. There was a reduction in all investigations performed (P < 0.001) except C-reactive protein (P = 0.448) between surveys. These included full blood count (76% to 61%); blood culture (70% to 53%) and testing of respiratory secretions for viruses (24% to 12%) and bacteria (18% to 8%). Compared to pre-guidelines, there was a reduction in the use of intravenous antibiotics as a proportion of the total prescribed from 47% to 36% (P < 0.001) and a change in the route of antibiotic administration with increasing preference for oral alone (16% pre-compared to 50% post-guidelines, P < 0.001).
  
  
  CONCLUSIONS
  Apart from the acute phase reactants that should not be measured routinely, these changes are in line with the guideline recommendations. Improvements in antibiotic use are possible and have implications for future antimicrobial stewardship programmes. Further work using cost-effectiveness analysis may also demonstrate a financial benefit to health services from adoption of guidelines.
authors.affiliation: Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elemraid
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Rushton
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Thomas
authors.forename: David A
authors.initials: DA
authors.lastname: Spencer
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Eastham
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Gennery
authors.forename: Julia E
authors.initials: JE
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D008828:Microbiological Techniques; D010372:Pediatrics / Q000458:organization & administration*; D011014:Pneumonia / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D000890:Anti-Infective Agents; D002097:C-Reactive Protein
keywords: antibiotics; antibiotics stewardship; children; investigations; management guidelines; pneumonia