Pediatric Community-Acquired Pneumonia

Publication Date: October 1, 2011

Key Points

Key Points

Pneumonia is the single greatest cause of death in children worldwide. Each year, more than 2 million children younger than 5 years die from pneumonia, representing approximately 20% of all deaths in children within this age group.

In the developed world, the annual incidence of pneumonia is approximately 3-4 cases per 100 children younger than 5 years. Incidence varies inversely with age.

Vaccines have dramatically decreased the incidence of infections, including community-aquired pneumonia (CAP).

Pathogens responsible for "atypical pneumonia" have been identified in 3% to 23% of children studied, with Mycoplasma pneumoniae more often identified in older children.

Viral etiologies of CAP have been documented in up to 80% of children younger than 2 years. In contrast, investigations of older children, 10-16 years, who had both clinical and radiographic evidence of pneumonia, documented a much lower percentage of viral pathogens.

Respiratory syncytial virus (RSV) is consistently the most frequently detected virus, representing up to 40% of identified pathogens in those younger than 2 years, but rarely identified in older children with CAP. Less frequently detected are adenoviruses, bocavirus, human metapneumovirus, influenza A and B viruses, parainfluenza viruses, coronaviruses and rhinovirus.

Diagnosis and Assessment

...Diagnosis and...

...Site of Care Ma...

...Hospital...

...dren and infants who have moderate to severe CA...

...6 months of age with suspected bacteri...

...ldren and infants with a suspicion or documentatio...

...dren and infants for whom there is concern abo...

...Intensive Car...

...child should be admitted to an intens...

...ould be admitted to an ICU or a unit with con...

...uld be admitted to an ICU or a unit...

...hould be admitted to an ICU or a unit with con...

...be admitted to an ICU if pulse oximetry is...

...should be admitted to an ICU or a unit...

...ity of illness scores should NOT be used as the...


...Diagnostic...

...Microbi...

...Blood Cu...

...should NOT be routinely performed in nontoxic...

...res should be obtained in children who fail to de...

...Bl...

...should be obtained in children req...

...patients who otherwise meet criteria fo...

...Follow-u...

...peat blood cultures in children with cle...

...t blood cultures to document resolution of...

...Sputum Gram S...

...tum samples for culture and Gram s...

...Uri...

...antigen detection tests are NOT re...

...Testing...

...ive and specific tests for the rapid diagnosi...

Antibacterial therapy is not necessary for child...

...respiratory viruses other than influen...

...Testing fo...

...n with signs and symptoms suspiciou...

Diagnostic testing for Chlamydophila pneumoniae is...

...Ancillary...

...Complete Bl...

...measurement of the complete blood count is NOT n...

...count should be obtained for patients with s...

...Acute-Phase Reacta...

...se reactants such as the erythrocyte...

...phase reactants need not be routinely mea...

...patients with more serious disease such a...

...Pulse O...

...ulse oximetry should be performed on all...

...Ches...

...Initia...

...ne chest radiographs are not necessary...

Chest radiographs, posteroanterior (PA) and...

...Initial Chest...

...t radiographs (PA and lateral) sho...

...Follow-up Ch...

...radiographs are not routinely requ...

...repeat chest radiograph should be obt...

...outine daily chest radiography is NOT recomme...

...llow-up chest radiographs should be obtained in...

...chest radiographs 4-6 weeks after th...


...Severe or Life-Threate...

...inician should obtain tracheal aspirates for Gr...

...scopic or blind protected specimen br...


...ications Associated With CAP...


...Criteria for Respiratory Distress...


...ble 3. Criteria for CAP Severity of...


Prevention

...be immunized with vaccines for bacterial pathogens...


...hildren and adolescents 6 months of age and o...


...caretakers of infants less than six m...


...neumococcal CAP following influenza virus in...


...gh-risk infants should be provided immune prop...


Table 4. Selection of Antimicrobial Therap...


Treatment

...Anti-infective...

...Outpatient...

...obial therapy is not routinely requi...

...lin should be used as first-line therapy for p...

...ld be used as first-line therapy for...

...acrolide antibiotics should be prescribed fo...

...viral therapy (Table 5) should be admin...

...penicillin G should be administered to the f...

...ric therapy with a third generation parenteral cep...

...mbination therapy with a macrolide (oral...

...in or clindmycin (based on local sus...

...Minimizing R...

...otic exposure selects for antibiotic resis...

...spectrum of activity of antimicrobials to...

...r dosage of antimicrobial to be able to achie...

...the shortest effective duration will...

...Duration of Antimicro...

...es of 10 days have been best studied, althoug...

...nfections caused by certain pathogens, notably...

...adequate therapy should demonstrate clinical and...


...Adjunctiv...

...Parapneumonic E...

History and physical examination may...

...ize of the effusion is an important...

...degree of respiratory compromise i...

...bacterial culture of pleural fluid sho...

...ing or nucleic acid amplification through p...

...lysis of pleural fluid parameters such as pH,...

Analysis of the pleural fluid white blood cell cou...

...icated parapneumonic effusions should NOT routin...

...umonic effusions associated with r...

...chest thoracostomy tube drainage with the ad...

...uld be performed when there is persistence o...

...e can be removed in the absence of...


...Antibio...

...or pleural fluid bacterial culture identifies a p...

...case of culture-negative parapneumonic...

...tion of antibiotic treatment depends o...

...Nonresponse...

...aboratory assessment to determine the cur...

...g evaluation to assess the extent and...

...igation to identify whether the original pat...

...n should be obtained for Gram stain and cultu...

...percutaneous lung aspirate should be o...

...ung biopsy for Gram stain and cultu...

...monary abscess or necrotizing pneumon...

...Discharg...

...atients are eligible for discharge when...

...gible for discharge when they demonstrate consis...

...are eligible for discharge only if the...

...tients are not eligible for discharge if they ha...

...should have documentation that they can tolera...

...r young children requiring outpatien...

...children who have had a chest tube...

...ildren with barriers to care including...

Ind...

...utpatient parenteral antibiotic thera...

...nt parenteral antibiotic therapy should be offe...

...to oral outpatient step-down therapy is preferre...


...uenza Antiviral Therapy (Please check the CD...


...ic Therapy for Pediatric CAP Site...


...ctors Associated with Outcomes and Ind...


...1. Management of Pneumonia with Parapneumonic...


Table 8. Available Antibacterials...