Bacterial pneumonias: management and complication.

The treatment of bacterial pneumonia can occur either in the community or hospital setting depending on the clinical status of the child. In the community, supportive management includes anti-pyretics, analgesia and early review by a medical practitioner if there is deterioration or no response to oral antibiotics within 48 hours. Suitable first-line antibiotics in the under fives are penicillin- or cephalosporin-based and in the over fives macrolides may also be considered. In a severely ill child, good oxygenation is essential and oxygen may be delivered by mask, nasal prong or headbox. Persistent fever, despite appropriate treatment warrants further investigations. The most common complication is an empyema and treatment is effective drainage with continuing high-dose antibiotics. Other lung complications include abscess formation and pneumatoceles. The syndrome of inappropriate anti-diuretic hormone secretion occurs in approximately one third of hospitalized patients with pneumonia. A rare but important complication is pericarditis.