BACKGROUND: Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive
immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies
have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children
improve aetiological diagnosis.
OBJECTIVE: To produce revised guidelines for pneumonia in South African children under 5 years of age.
METHODS: The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established
seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic
management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert
opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an
overall guideline which underwent peer review and revision.
RECOMMENDATIONS: Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific
recommendations for HIV infected and HEU children are provided.
VALIDATION: The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts.
Recommendations are consistent with those in published international guidelines.