Short antibiotic courses for childhood pneumonia and sinusitis rose from 13% to 65% with a pathway and prompts

The edition in brief

A quality improvement project in Pediatrics, published on 13 October, raised the share of children discharged from one US paediatric emergency department with community-acquired pneumonia or acute bacterial sinusitis on a guideline-recommended short antibiotic course from 13.1% to 64.8%. The tools were a clinical pathway, electronic record changes, prescriber education and feedback. Return visits within 14 days did not rise. Current guidance supports 3 to 5 days for uncomplicated pneumonia and 5 to 7 days for sinusitis. A meta-analysis of eight randomised trials and 1,000 children found no significant difference in seizure freedom between levetiracetam and valproate (RR 0.95, 95% CI 0.83 to 1.09), with low-certainty evidence; levetiracetam had fewer adverse events and less weight gain. Time-to-event outcomes favoured valproate but were exploratory. A UK eDelphi of paediatric respiratory experts agreed ten clinical features consistent with dysfunctional breathing in children and young people, a first step towards a validated assessment tool. The pearl covers telling dysfunctional breathing from asthma.