No gold standard currently exists for the diagnosis of bacterial pneumonia, including CXR (Lynch, Bialy et al. 2010) limiting the methodology of studies attempting to develop prediction tools to link clinical symptoms with bacterial disease.
We strongly recommend based on low quality evidence consideration of further evaluation including repeat CXR, change in antibiotics or ID consultation in a patient without clinical improvement after 48-72 hours of therapy
We strongly recommend based on low quality evidence transition to oral high dose amoxicillin (80-100 mg/kg/day divided twice a day) when clinically indicated and at discharge to complete a total course of antibiotics of 5-7 days.
A focal consolidation on chest x-ray without pleural effusion.
These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.