{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T17:48:36Z","timestamp":1764784116887},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,7,27]],"date-time":"2018-07-27T00:00:00Z","timestamp":1532649600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Community\u2010acquired pneumonia (CAP) complicated by pleural empyema is an important paediatric problem. Antibiotic management decisions are made on the basis of little available data and without strong specific recommendations in guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an online survey of paediatric infectious diseases (PID) physicians disseminated by major international professional organisations, examining empiric and targeted antibiotic choice, switch to oral antibiotics and duration of treatment for two hypothetical cases of contrasting severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 183 responses, mostly from North America, Western Europe and Australia\/New Zealand. Increased disease severity was significantly associated with broader\u2010spectrum and combination empiric and targeted antibiotic treatment, empiric methicillin\u2010resistant <jats:styled-content style=\"fixed-case\"><jats:italic>Staphylococcus aureus<\/jats:italic><\/jats:styled-content> (MRSA) coverage and both longer intravenous (IV) and total duration of antibiotic treatment. Empirical MRSA coverage was also associated with local prevalence. Clinical progress was most important for determining the timing of the switch from IV to oral antibiotics. Few respondents chose antibiotics with activity against organisms associated with atypical pneumonia (e.g. <jats:italic>Mycoplasma<\/jats:italic>, <jats:italic>Chlamydia<\/jats:italic>), and most did not choose agents that inhibit protein synthesis (e.g. clindamycin), even in the case of a severe invasive group A streptococcal infection. Some variation in targeted treatment choices reflected areas of uncertainty, such as <jats:styled-content style=\"fixed-case\"><jats:italic>Streptococcus pneumoniae<\/jats:italic><\/jats:styled-content> susceptibility breakpoints, comparative effectiveness of anti\u2010staphylococcal penicillins and first\u2010generation cephalosporins for serious <jats:styled-content style=\"fixed-case\"><jats:italic>S. aureus<\/jats:italic><\/jats:styled-content> infections and linezolid and vancomycin for MRSA pneumonia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This international survey of PID physicians highlights the priority targets for clinical research to improve antibiotic treatment of CAP complicated by empyema. Interventions that might be studied include empirical antibiotic guidelines stratified by case severity, adjunctive empirical use of agents that inhibit protein synthesis (e.g. clindamycin) and approaches to encourage rapid IV\u2010to\u2010oral switch and shorter total antibiotic treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.14128","type":"journal-article","created":{"date-parts":[[2018,7,27]],"date-time":"2018-07-27T07:41:00Z","timestamp":1532677260000},"page":"66-73","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["International survey of paediatric infectious diseases consultants on the management of community\u2010acquired pneumonia complicated by pleural empyema"],"prefix":"10.1111","volume":"55","author":[{"given":"Joshua","family":"Osowicki","sequence":"first","affiliation":[{"name":"Group A Streptococcus Research Group Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Melbourne Victoria Australia"},{"name":"Infectious Diseases Unit, Department of General Medicine Royal Children's Hospital Melbourne  Melbourne Victoria Australia"},{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics University of British Columbia, BC Children's Hospital  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew C","family":"Steer","sequence":"additional","affiliation":[{"name":"Group A Streptococcus Research Group Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Melbourne Victoria Australia"},{"name":"Infectious Diseases Unit, Department of General Medicine Royal Children's Hospital Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,7,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/650573"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-3109"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.12.109231"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e318275614b"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3182784ec1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1710.101825"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir531"},{"key":"e_1_2_11_9_1","first-page":"425","article-title":"Paediatric complicated pneumonia: Diagnosis and management of empyema","volume":"16","author":"Chibuk T","year":"2011","journal-title":"Paediatr. 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