Paediatric respiratory disease remains an important cause of morbidity in both the developing and the developed world. In the UK respiratory illness is the most common reason parents cite for taking their children to see the general practitioner, and for attendance to the emergency department with a paediatric medical problem.¹

Community acquired pneumonia (CAP) refers to an infection of the lung by a variety of microorganisms acquired outside the hospital setting, resulting in inflammation of the lung tissue. It is typically associated with fever and respiratory symptoms such as cough and tachypnoea, but symptoms may be non-specific in young children. Radiographic changes may be useful to confirm the diagnosis. It remains an important cause of death in children throughout the world, especially in developing countries. Fortunately in the UK death in previously well children is an extremely rare consequence of CAP and most children do not need to be admitted to hospital for treatment. The groups at highest risk of long term morbidity and mortality include infants (especially low birth weight or premature), those who are immunocompromised, and those who have other underlying conditions such as cystic fibrosis or congenital heart disease. This article does not aim to address the management of children with such conditions.

Despite pneumonia being a condition commonly encountered by clinicians, uncertainty remains over the diagnosis, investigation, and treatment of the condition. The British Thoracic Society (BTS) has published clinical guidelines which provide an evidence base for the management of CAP.² The guidelines recognise, however, that there are still some recommendations based on consensus opinion due to the lack of available evidence. The aim of this article is to update the clinician on the management of CAP based on a combination of recommendations from the BTS guidelines,² and current literature.

EPIDEMIOLOGY AND AETIOLOGY

Pneumonia is most …