Grant: Project Grant

In North America, up to 5% of preschoolers develop pneumonia every year and pneumonia is the second-leading cause of paediatric hospitalization. Consequently, it is critical to ensure that pneumonia treatment strategies are based on the best evidence and latest science. Most childhood pneumonia is caused by viruses, for which no specific treatment is available. However, most doctors still prescribe antibiotics to the majority of children diagnosed with pneumonia in Canadian emergency departments (EDs). Antibiotics will help for the small minority of children with bacterial infections, but will not help at all for the many children who have viral infections - and antibiotics can also cause significant harms. These harms include facilitating the development of antibiotic resistance, harming the 'good' bacteria that live in children's bodies, and side effects such as anaphylaxis, diarrhoea, and rashes. We have developed a new care pathway which can help doctors identify which children with pneumonia are at significant risk of having a bacterial infection. This way, children who are likely to have viral infections can be spared the potential harms of receiving antibiotics that will not make their illness resolve faster. We will conduct a clinical trial at Canadian paediatric EDs, enrolling children diagnosed with non-severe pneumonia, and will randomize them to either standard care (whatever the ED physician ordinarily would have prescribed) or the new care pathway. The care pathway incorporates specific features on imaging, a finger-poke rapid blood test, and novel respiratory virus testing. We hypothesize that the use of this new care pathway will lead to significantly less antibiotic use, but children managed using the pathway will get better just as fast as children who get treated using standard care.