Background: The rapid detection of Streptococcus pneumoniae could assist in the management of pneumococcal infections. The Binax NOW S. pneumoniae test is a rapid immunochromatographic test for this purpose. Methods: Multiplex PCR in parapneumonic pleural effusion fluid (PPEF) and cerebrospinal fluid (CSF) with Binax NOW urinary pneumococcal antigen test (PAT) from 80 children was compared in this study. Results: PAT had a sensitivity of 36.4%, specificity of 97.3%, in CSF. PAT had a sensitivity of 50%, specificity of 81% for parapneumonic pleural effusion fluid. Conclusions: When rapid management of a serious infection is needed the Binax NOW test could be a reliable method for the exclusion of S. pneumoniae infection.