Necrotising pneumonia in children.

Necrotising pneumonia remains an uncommon complication of pneumonia in children but its incidence is increasing. Pneumococcal infection is the predominant cause in children but Methicillin resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL) staphylococcal infection are also important causes of severe necrotising pneumonia. Clinical features of necrotic pneumonia are similar to those of an uncomplicated pneumonia except that the patient is clinically much more unwell and has usually failed to respond adequately to what would normally be considered as appropriate antibiotics. Pleural involvement is frequent. Initial management is similar to that for non-complicated pneumonia with careful attention to fluid balance and adequate analgesia required. Some patients will need intensive care support, particularly those with PVL-positive staphylococcal infection. Broad-spectrum antibiotics should be given intravenously, with the exact choice of agent informed by local resistance patterns. Pleural drainage is often required. Despite the severity of the illness, outcomes remain excellent with the majority of children making a full recovery.