CONCERNING THE DIAGNOSTIC AND TREATMENT PROBLEMS OF CHILDREN WITH PNEUMONIA
Background: Pneumonia is one of the most frequent serious potentially life threatening childhood diseases. The criteria for diagnostics and treatment were designed long ago and are clearly articulated. Nevertheless, diagnostics and therapy happen most often during outpatient management. Objective: The aim was to compare the diagnostic criteria of CAP among children in Russian and foreign guidelines and also to compare the incidence. Another aim is to find out the aptness to the Russian guidelines for the management of CAP among children. Materials and methods: The comparative analysis of childhood pneumonia diagnostics and treatment guidelines have been recently published in a range of countries. We reviewed some recently published pneumonia recommendations. The timeliness and adequacy of hospitalization and treatment was analyzed for 167 hospitalized children with pneumonia diagnosed according to Russian and WHO recommendations. We also used the information about the quality of X-ray pneumonia diagnosis in 679 patients from hospitals in Barnaul, Ekaterinburg and Murmansk (PAPIRUS research project). Results: We found a high percentage of late (5-th day and later) hospitalization of children with pneumonia (37 percent in 2002-2007 and 47 percent in 2013-2014) as well as a late (≥ 5 days) start of therapy (20 and 34 percent accordingly). In three regional hospitals only 27 percent of X-ray films of children treated for pneumonia were attested as meeting the pneumonia criteria. We found a high frequency of macrolides as a starting therapy in typical pneumonia which often had been ineffective. Amoxicillin/clavulanate and oral cephalosporins were also ineffective in doses < 45 mg/kg/day. A poor knowledge of the clinical features of atypical pneumonia was noted with a corresponding high frequency of β-lactams as a starting medication. Conclusion. Our data shows the importance of training paediatricians in modern pneumonia diagnosis and treatment.