![]() ![]() Reducing inappropriate antibiotic use in patients with nonpneumonia lower respiratory tract infections by 30% would yield a much larger benefit than reducing antibiotic use in patients with CAP by the same amount. The Pediatric Infectious Diseases Society and Infectious Diseases Society of America national childhood community-acquired pneumonia (CAP) guideline encouraged the standard evaluation and treatment of children who were managed as outpatients. This study is funded by the Agency for Healthcare Research and Quality and involves data collection in Madison, Wis. Systematic approach to the chest film using an inside-out approach. The interpretation of a chest film requires the understanding of basic principles. In fact every radiologst should be an expert in chest film reading. 3 My colleagues and I are in the process of gathering prospective data on 1,400 patients with acute cough, to learn more about how to identify patients with acute cough who are unlikely to benefit from antibiotics. The chest x-ray is the most frequently requested radiologic examination. However, a study found that C-reactive protein has independent predictive value for identifying lower respiratory tract infections caused by a bacterial pathogen. In addition, as he notes, data are lacking regarding which patients with radiographic CAP benefit from an antibiotic. To that end, identifying patients who are unlikely to have radiographic CAP may be helpful. However, because approximately 70% of patients with acute cough receive an antibiotic, 1 and only 4% of primary care patients with cough are diagnosed with CAP, 2 the larger task is reducing inappropriate antibiotic use among those without CAP rather than in those with CAP. He correctly notes that not all patients with radiographic CAP benefit from an antibiotic. Tanael for his thoughtful letter and agree with his comments, with some caveats. is a similar picture to that of congestive heart failure under other clinical circumstances.In Reply: I thank Dr. There is diffuse, mostly reticular, interstitial lung disease greater at the bases. Is follow up X-ray required in a child with clinical and radiological findings in-keeping with round pneumonia. Transbronchial or transthoracic or open lung Bx.Punctate / rimlike calcifications within enlarged lymph nodes and abdominal viscera.Disseminated extrapulmonary disease (1%).Spontaneous pneumothorax, frequently bilateral (6-7%).Redistribution of infection to upper lobes.Effect of prophylactic use of aerosolized pentamidine.Usually responds to therapy in 5-7 days.Bilateral and diffuse Ga-67 uptake without mediastinal involvement prior to roentgenographic changes.Pulmonary cavities usually due to superimposed fungal / mycobacterial infection.Thin-walled spaces without lobar predilection resolving within 6 months.Bilateral, symmetric / asymmetric, reticular markings (thickening of lobular septa).Bilateral, diffuse air-space disease in symmetric distribution.Bilateral, asymmetric patchy mosaic appearance.Extended use of CXR does not result in decreased rates of antibiotic. Cavities with predilection for upper lobes The doctor's degree of suspicion as a predictor of pneumonia We found.Isolated lobar disease / focal parenchymal opacities.Pleural effusion and hilar lymphadenopathy are uncommon.Resembles non-cardiogenic pulmonary edema.Rapid progression to diffuse airspace disease Among the pathological X-rays, 168 (36) showed increased density in the form of ground-glass opacities, while 202 showed lung consolidation (43.3).Bilateral diffuse symmetric finely granular / reticular interstitial / airspace infiltrates in 80%.Lymphopenia (50%) indicates poor prognosis.Subacute insidious onset of malaise and slight cough (frequent in AIDS patients).Mycobacterium avium-intracellulare (MAI).Patients on long-term corticosteroid therapy.Protozoan / fungus Pneumocystis carinii (jiroveci).Most common cause of interstitial pneumonia in immunocompromised patients. ![]()
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