ABSTRACT
Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence; severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective: To develop guidelines for the diagnosis; management and prevention of CAP in South African children. Methods: The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence; expert opinion was accepted. After peer review and revision; the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations: Recommendations based on epidemiological factors include a diagnostic approach; investigations; supportive therapy; appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation: These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in aediatrics; paediatric pulmonology; radiology; infectious diseases and microbiology. Published international guidelines have also been consulted