Table 8

 Key recommendations of guidelines2,25

• A child over 2 months old presenting in the community with clinical signs consistent with pneumonia does not require any microbiological or radiological investigation before initiating treatment
• Despite blood cultures having a low sensitivity it is still recommended that they should be performed on all children admitted to hospital with pneumonia
• Acute phase reactants do not help distinguish between viral and bacterial pneumonia and should not be measured routinely
• A child <5 years old presenting to hospital with pyrexia (>39°C) of unknown origin should be considered for a chest radiograph
• Consolidation is the only reliable sign for the diagnosis of pneumonia
• There is currently no consensus as to whether all children admitted to hospital with clinically diagnosed pneumonia should have a chest radiograph. In fact, both guidelines highlight the difficulty with clinicians basing their diagnosis on the radiograph
• Further research is required to develop affordable, specific, and sensitive investigations for the diagnosis of bacterial and viral pneumonia
• Amoxicillin is the first choice for oral antibiotic treatment in children <5 years old; alternatives are co-amoxiclav, cefaclor, erythromycin, clarithromycin, and azithromycin
• Because mycoplasma pneumonia is more prevalent in older children, macrolide antibiotics may be used as first line empirical treatment in children aged ⩾5 years
• Amoxicillin administered orally is effective for children >6 months who are well enough to be treated without hospital admission
• Intravenous antibiotics should be used in the treatment of pneumonia in children when the child is unable to absorb oral antibiotics or presents with severe symptoms and signs