Managing Bacterial Pneumonia in Children Without Antimicrobials

Study Overview
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Brief Summary
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Retrospective cohort analysis of children hospitalized for pneumonia comparing disease severity on admission, clinical course, treatment and outcomes and prospective telephone based Follow-Up assessement.

Detailed Description
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The investigators will conduct a retrospective cohort analysis of children hospitalized for pneumonia at the Filderklinik between December 2006 and November 2010. The Bacterial Pneumonia Score, a validated composite laboratory, clinical and radiologic score developed by Moreno et al, will be retrospectively applied to define cases as either viral or bacterial pneumonia. The investigators will compare disease severity on admission, clinical course, and outcomes (in terms of complications, length of stay and readmission rates) between antimicrobial and non-antimicrobial managed bacterial pneumonia cases. Long-term Follow-Up will be assessed by telephone interviews with the parents.

Official Title
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Can Community-acquired Bacterial Pneumonia in Children be Safely Managed Without Antibiotics in an Integrative Medicine Context? A Retrospective Cohort Analysis

Conditions
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Pneumonia

Intervention / Treatment
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* Other: Multimodal Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hospital admission at the pediatric department of the Filderklinik. Admission diagnosis pneumonia (ICD J12.0, J12.1, J12.8, J12.9, J14, J15.1, J15.6, J15.7, J15.8, J15.9, J16.8, J18.0, J18.1, J18.8, J18.9 - all 12s, 15s, 16s, 18s) Exclusion Criteria: None

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Multimodal Therapy|Drugs, external applications like chest wraps, inhalations|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cure rate of non-antimicrobial management of bacterial pneumonia | Cure rate of non-antimicrobial management of bacterial pneumonia (in the following and in the final publication, the term bacterial pneumonia will be used for children who fulfill the Moreno criteria for pneumonia): % of children managed without antimicrobials since admission, without subsequent need for antimicrobials or readmission. | Between admission and 3 months after discharge | 
| Medical complication rate | Medical complication rate among children with bacterial pneumonia, treated with or without antimicrobials | Between admission and 3 months after discharge | 
| Length of hospital stay | Length of hospital stay for children with bacterial pneumonia, managed with or without antimicrobials | Between admission and 3 months after discharge | 
| Readmission rate | Readmission rate for pneumonia among children with bacterial pneumonia, managed with or without antimicrobials | 7 - 10 years after hospitalization | 
| Temperature normalization | Days to temperature normalization (< 38°C) in children with bacterial pneumonia, managed with or without antimicrobials | Between admission and 3 months after discharge | 
| Days of supplemental oxygen need | Days of supplemental oxygen need in children with bacterial pneumonia, managed with or without antimicrobials | Between admission and 3 months after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in respiratory rate | Changes in respiratory rate as an indicator for pulmonary infection | Between admission and 3 months after discharge | 
| Changes in Bacterial Pneumonia Score | Changes in Bacterial Pneumonia Score as an indicator for pulmonary infection | Between admission and 3 months after discharge | 
| Changes in oxygen saturation | Changes in oxygen saturation as an indicator for pulmonary infection | Between admission and 3 months after discharge | 
| Changes in CRP | Changes in CRP as an indicator for infection | Between admission and 3 months after discharge | 
| Changes in leukocyte count | Changes in leukocyte count as an indicator for infection | Between admission and 3 months after discharge | 
| Changes in pH | Changes in pH as an indicator for respiratory distress | Between admission and 3 months after discharge | 
| Changes in pCO2 | Changes in pCO2 as an indicator for respiratory distress | Between admission and 3 months after discharge | 
| Rate of chronic and acute-infectious co-morbidities | Rate of chronic and acute-infectious co-morbidities on admission in children with bacterial pneumonia, subsequently managed with or without antimicrobials | Day of admission | 
| Utilization rate of a package of complementary treatment measures | Utilization rate of a package of complementary treatment measures from anthroposophic medicine (including oral medications, inhalation and external nursing applications) in children managed with or without antimicrobials | Between admission and 3 months after discharge | 
| Antimicrobial treatment rate in children with viral pneumonia | Antimicrobial treatment rate in children classified as viral pneumonia by Bacterial Pneumonia Score | Between admission and 3 months after discharge | 
| Number of patients treated with antipyretics | Number of patients treated with antipyretics | Between admission and 3 months after discharge |