S aureus pneumonia: Pneumatoceles occasionally leading to pneumothorax are commonly seen with S aureus pneumonia. The long term outlook is good with normal lung function
Mycoplasma pneumonia: Complications in almost every body system have been reported in association with M pneumoniae. Rashes are common; the Stevens-Johnson syndrome occurs rarely; haemolytic anaemia, polyarthritis, pancreatitis, hepatitis, pericarditis, myocarditis and neurological complications including encephalitis, aseptic meningitis, transverse myelitis and acute psychosis have all been reported
Physiotherapy did not have any effect on the length of hospital stay, pyrexia, or chest radiographic findings in patients with pneumonia.
There is no evidence to support the use of physiotherapy including postural drainage, percussion of the chest, or deep breathing exercises. There is a suggestion that physiotherapy is counterproductive, with patients who receive chest physiotherapy being at risk of having a longer duration of fever than the control group.
Systematic Glucocorticoides in wheezing in Children
Current data do not support the clinical efficacy of glucocorticoids in expiratory wheezing in hospitalized children age <2 years.
In outpatients <2 years of age systemic glucocorticoid treatment may induce clinical and hospitalization benefit.
In contrast patients older than 3 years of age with acute asthma clearly benefit from systemic glucocorticoids.
It is not known whether the differences in the efficacy are related to the differences in viral etiology (RSV vs. rhinovirus), airway diameter, mucus clearance, immunologic maturity or age of the patient
The First Wheezing Episode. Six studies focused on the first wheezing episode. Schuh et al.[found that oral dexamethasone given at the emergency department decreased the rate of hospitalization by 57% Goebel et al.[found that children receiving prednisolone had a better clinical score on the second day. The majority of patients were managed as outpatients. On the other hand four studies did not find prednisone or dexamethasone effective in hospitalized children.
At Least One Previous Wheezing Episode. Fox et al included patients who had suffered at least one previous wheezing episode but did not find prednisolone effective in hospitalized children
Infants Younger Than 12 Months. Two studies concentrated on the efficacy of systemic steroids for expiratory wheezing in children younger than 1 year). In a study of 46 children Tal et al. found that a combination of dexamethasone and salbutamol improved the clinical score of the children, but the duration of hospital treatment remained the same. On the other hand Roosevelt et al. did not find dexamethasone to be better than placebo in a larger study of 118 children.
Other Studies in Children Younger Than 3 Years. Eight other studies were of age ranges up to 3 years ( Table 1 ). All children were treated in a hospital. Statistically significant differences in favor of systemic glucocorticoids were found in one-third of the studies. Csonka et al. (submitted for publication) reported that prednisolone reduced the number of long hospitalizations (three nights or more). Van Woensel et al. studied the efficacy of prednisolone in RSV bronchiolitis. Children receiving prednisolone who did not need mechanical ventilation had a better clinical score during the first 3 days, but the duration of hospital stay remained the same. In children receiving mechanical ventilation the duration of hospital stay was shorter in the prednisolone group, but the duration of ventilation therapy was similar in both groups. Daugbjerg et al. found that the clinical score of children receiving prednisolone improved sooner and that the children left the hospital earlier.