INTRODUCTION:

Pneumonia is defined as infection of lung parenchyma mainly the alveoli by microbial agents. In most of the cases it is difficult to identify the causative organism(1). Pneumonia is one of the most important causes of childhood morbidity and mortality; especially in developing regions (2)some methods used for detection of the aetiologic agents include blood culture, lung puncture,nasopharyngeal aspiration and immune assays of blood andurine tests (3).Practical antibiotic administration is the basis of treatment of pneumonia in children. Administration of appropriate antibiotic as first-line medicine may improve outcome of pneumonia. Multiple antibiotics are prescribed for treatment of pneumonia(4). In 1994 the Anti-infective Guidelinesfor Community-acquired Infectionswere published as a guide for primary caregivers in Ontario(5). Worldwide, pneumonia has not been included among reportable diseases in the official systems(6). Traditionally, for bacterial pneumonia, laboratory inspection systems have provided invaluable reports focusing on serotype distribution and materialization of antimicrobial resistance of selected isolates among hospitalized pneumonia cases(7). There has been a great effort to systematically collect identical laboratory data in both developed and developing countries, supported by international agencies (8)

It is estimated that a total of around 156 million new episodes occur each year and most of these occur in India (43 million), China (21 million)(9), Pakistan (10 million) and Bangladesh, Indonesia and Nigeria (six million each) (10).

ETIOLOGY

Gram-positive bacterial pneumonia (11)

Streptococcus is the most common bacterial cause of pneumonia in all age groups.

Streptococcus pneumonia often lives in the throat of people who do not have Pneumonia(12).

Other important Gram-positive causes of pneumonia are Staphylococcus aureus (J 15.2) and Bacillus anthracis.

Gram-negative bacterial pneumonia (13)

Gram-negative bacteria are seen less frequently-

· Influenzae,

· Klebsiella pneumoniae (14)

· Escherichia coli,

· Pseudomonas aeruginosa(15)

· Bordetella pertussis

· Moraxella catarrhalis are the most common.

These bacteria are seen in our gut and enter our lungs when inhaling gut contents (vomit and feaces) Atypical bacterial pneumonia (16)

· Coxiella burnetii,

· Chlamydophila pneumoniae,

· Mycoplasma pneumoniae

· Legionella pneumophila

They are called atypical bacteria because they do not stain as both gram positive and gram negative bacteria.

Pneumonia caused by Yersinia pestis is usually called pneumonic plague.

Identifying the cause of pneumonia in children is difficult because of the lack of rapid, commercially available, accurate laboratory tests for most pathogens. Thus, empirical therapy is the common course in most cases

SIGNS AND SYMPTOMS:

There are various signs and symptoms of Pneumonia:

· WHO(identification of pneumonia on clinical symptoms/signs and administration of empirical antimicrobial agents) has found reduction in mortality as well as pneumonia-related mortality (17)

· wheeze, asthma(18)

· Respiratory symptoms or signs of fever > 37.5°C, 4

· Radiological diagnosis of pneumonia (19)

· Prematurity,

· Malnutrition in children(20)

· Toxic appearance (21)

· Severe respiratory distress syndrome(22)

· Oxygen requirement increases(23)

· Dehydration (24)

· Frequent Vomiting (25)

· Headache and pharyngitis.(26)

· Underlying disease, especially that affecting the cardiopulmonary, immune or nervous systems, also increases the risk of severe pneumonia; (27)

· In most studies the specific cause of pneumonia could not be identified in 40% to 60% of cases. (28)(29)

· Teeth chattering(30)

· Pneumococcal pneumonia can cause coughing up of blood or Hemoptysis associated with rusty sputum(31)

· Abnormally sleepy

· Difficulty to wake(32)

· Inability to drink

· Renal failurecases(33)

DIAGNOSIS:

· Chest radiographyachieves high specificity in the pneumoniadiagnosis.(34)

· HRCT Scanning(35)

· Lung Biopsy(36)

· Initial Pulmonary Function Test and Bronchoalveolar Lavage Findings(37)

· Pulmonary Function Test(38)

· Tachypnoea (50 breaths/minute in children aged 2 to 11 months and 33 breaths/minute in children aged 12 to 59 months)(40)

· Bacterial meningitis is very common(39)

· Empyema,

· Septic shock,

· Modification of antibiotic treatment(41)

· Voluntary withdrawal

· Hypoxaemic pneumonia at 10 to 12 daysand 21 to 30 days, with oxygen saturations

· Bacterial pathogens isolated from blood or other sterile sites

· Antimicrobial susceptibility of the isolated pathogens(42).

TREATMENT:

Antibiotics are the treatment of choice for bacterial pneumonia. The antibiotic choice depends on the nature of the pneumonia, the microorganisms most commonly causing pneumonia in the geographical region, and the immune status and underlying health of the individual. In UK, Amoxicillin is used as first-line therapy in the vast majority of patients acquiring pneumonia. In North America, clarithromycin, azithromycin, or fluoroquinolones as single therapy.(43)

Gram-positive organisms

Streptococcus pneumoniae can be treated with amoxicillin(44)or erythromycin in patients allergic to penicillin or cefuroxime and erythromycin in severe cases.

Staphylococcus aureus can be treated with antibiotics such as flucloxacillin to neutralize the organism's β-lactamase).

Gram-negative organisms

· Haemophilus influenzae is treated with benzylpenicillin (45)and 3rd generation Cephalosporins such as Cefaclor

· Pseudomonas aeruginosa with ciprofloxacin(46)

· Moraxella catarrhalis

Atypical organisms

· Chlamydophila pneumonia -Azithromycin

· Chlamydophila psittaci — erythromycin

· Mycoplasma pneumoniae — erythromycin(47)

· Coxiella burnetti — Chloramphenicol (48) with ampicillin

· Legionella pneumophila — erythromycin, with rifampicin sometimes added.

People with difficulty in breathing may require extra oxygen through artificial ventilation and intensive care as life-saving measures while their immune system fights off the disease caused with the help of antibiotics and drugs. (49)

PROGNOSIS:

The prognosis is good. Most cases of viral pneumonia resolve without treatment (50)common bacterial pathogens and atypical organisms respond to antimicrobial therapy. Long-term effects of pulmonary function is rare, even in children that has been complicated by empyema or lung abscess. (51)

Only Patients placed on a protocol-driven pneumonia clinical pathway are more likely to have favorable outcomes. The prognosis for varicella pneumoniais somewhat more guarded. Staphylococcal pneumonia, although rare, can be very serious despite treatment (52).

PREVENTION:

Prevention of bacterial pneumonia is by vaccination against Streptococcus pneumoniae (pneumococcal polysaccharide vaccine for adults (53) and pneumococcal conjugate vaccine for children(54), Haemophilus influenza type B, meningococcus, bordetellapertussis, bacillusanthracis, and yersiniapestis.(55)

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Received on 29.03.2014 Modified on 25.05.2014

Research J. Pharm. and Tech. 7(8): August 2014 Page 942-945