Pediatric Community-Acquired Pneumonia
Key Points
Key Points
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
...iagnosis and Assessm...
Site of Care Management Decisio...
Hospita...
...ants who have moderate to severe CAP2 as defined...
...3-6 months of age with suspected bac...
...nd infants with a suspicion or documentation...
...nd infants for whom there is concern ab...
...ntensive Care Unit
...hild should be admitted to an intensive care unit...
...should be admitted to an ICU or a...
A child should be admitted to an I...
...ld should be admitted to an ICU or a u...
...hild should be admitted to an ICU if pulse o...
...ild should be admitted to an ICU or a unit...
...ty of illness scores should NOT be used a...
...agnostic Testi...
...crobiologic Testi...
...d Cultures: Outpatient
...hould NOT be routinely performed in nontoxic, ful...
...ltures should be obtained in children...
...od Cultures: Inpatient...
...od cultures should be obtained in children...
...improving patients who otherwise meet...
...p Blood Cultures...
...blood cultures in children with clea...
...d cultures to document resolution of ba...
...am Stain and Culture...
Sputum samples for culture and Gram stai...
...ntigen Detection Tests...
...gen detection tests are NOT recommended for the di...
Testing For Viral Patho...
...ecific tests for the rapid diagnosis of in...
...acterial therapy is not necessary for children, ei...
...ing for respiratory viruses other than influen...
Testing for Atypical B...
...with signs and symptoms suspicious for M. pneumoni...
...testing for Chlamydophila pneumoniae i...
...Diagnostic Testing...
...mplete Blood Co...
...e measurement of the complete blood count is NOT...
...lete blood count should be obtained for patients...
...e-Phase Reactants...
...actants such as the erythrocyte sedim...
...e reactants need not be routinely measured in fu...
...h more serious disease such as those requiri...
...se Oximetry...
...imetry should be performed on all...
...est Radiography...
...st Radiographs: Outpatient...
...adiographs are not necessary for the con...
...aphs, posteroanterior (PA) and lateral,...
...al Chest Radiographs: Inpatient...
...ographs (PA and lateral) should be performed...
...p Chest Radiograph...
...t radiographs are not routinely required in ch...
...adiograph should be obtained in ch...
...daily chest radiography is NOT recomm...
...est radiographs should be obtained in patients wit...
...adiographs 4-6 weeks after the diagnosis o...
...Life-Threatening CAP...
...ian should obtain tracheal aspirates for...
...hoscopic or blind protected specim...
...mplications Associated With CAPHaving trouble vie...
...a for Respiratory DistressHaving tr...
...riteria for CAP Severity of IllnessaHaving tr...
Prevention
...revention...
...d be immunized with vaccines for bacterial patho...
...nd adolescents 6 months of age and older sho...
...takers of infants less than six months of age, in...
...mococcal CAP following influenza virus infecti...
...k infants should be provided immune proph...
...ble 4. Selection of Antimicrobial Therapy...
Treatment
...reatment...
Anti-infective
...patient...
...l therapy is not routinely required for p...
...n should be used as first-line thera...
...should be used as first-line therapy for p...
...ide antibiotics should be prescribed for trea...
...uenza antiviral therapy (Table 5) sh...
Inpatien...
...in or penicillin G should be administered...
...c therapy with a third generation par...
...combination therapy with a macroli...
...lindmycin (based on local susceptibility data) s...
...izing Resistance...
...xposure selects for antibiotic resista...
...imiting the spectrum of activity of...
...r dosage of antimicrobial to be abl...
...the shortest effective duration wi...
...uration of Antimicrobial Ther...
...atment courses of 10 days have been best st...
...caused by certain pathogens, notably CA-...
Follow-up
...adequate therapy should demonstrate cl...
...ctive Surgical and Non–Anti-infective Therapy...
Parapneumonic Effusi...
...ory and physical examination may be sugg...
The size of the effusion is an important f...
...’s degree of respiratory compromise...
...and bacterial culture of pleural fluid should be p...
...g or nucleic acid amplification through polymerase...
...ural fluid parameters such as pH, gluco...
Analysis of the pleural fluid white...
...cated parapneumonic effusions should N...
...te parapneumonic effusions associate...
...thoracostomy tube drainage with the a...
...ATS should be performed when there is per...
...an be removed in the absence of an intrath...
...otic Therapy for Parapneumonic Effusion/Empye...
...od or pleural fluid bacterial culture...
...he case of culture-negative parapneum...
...duration of antibiotic treatment depends...
...onresponse
...d laboratory assessment to determin...
...aluation to assess the extent and progres...
...tigation to identify whether the orig...
...BAL specimen should be obtained for...
...percutaneous lung aspirate should be ob...
...n open lung biopsy for Gram stain and culture shou...
...scess or necrotizing pneumonia identified in a n...
Discharge Criter...
...re eligible for discharge when they have documen...
Patients are eligible for discharge when they d...
...re eligible for discharge only if they...
...not eligible for discharge if they ha...
...should have documentation that they ca...
...or young children requiring outpati...
...dren who have had a chest tube and meet the...
...nfants and children with barriers to care i...
...or Parenteral Outpatient Therapy...
...parenteral antibiotic therapy should be offered...
...t parenteral antibiotic therapy should be of...
...oral outpatient step-down therapy is...
...uenza Antiviral Therapy (Please che...
...ble 6. Empiric Therapy for Pediatri...
...able 7. Factors Associated with Outcomes and...
...ement of Pneumonia with Parapneumonic Effus...
...able AntibacterialsHaving trouble viewing table? E...