Introduction: Distinguishing bacterial from viral pneumonia on admission to the hospital could guide the decisión of whether or not to use antibiotics. Objective: Fo evaluate the accuracy of chest radiograph to predict etiology (bacterial or viral) in 141 children aged under 10 years, hospitalized for pneumonia in whom bacterial (n = 24) or viral (n = 117) etiology was identified. Methods: Chest radiograph evaluation was based on Khamapirad score (-3 to 7 points), and blinded with regard to etiology. Results: Radiographic score was higher in bacterial pneumonias than in viral pneumonías (3.9 ± 0.92 vs - 1.6 ± 1.3 points; p < 0.0001). Optimum cut-off value for the score was identified (ROC curve) at ≥ 2 points (sensitivity: 100%; specificity: 94 %; positive predictive value: 77%; negative predictive value: 100%). Conclusión: Fhe score tested is based on easily identifiable elements in the chest radiograph. It accurately identifies children who do not need antibiotics, it could be helpful in the management of community acquired pneumonia