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 Assessmen...

...are Management Decisio...

Hospit...

...and infants who have moderate to severe CAP...

...nts 3-6 months of age with suspect...

...nfants with a suspicion or documentation of CAP...

...ren and infants for whom there is...

...ive Care Unit...

...be admitted to an intensive care unit (I...

...be admitted to an ICU or a unit with continuous c...

...be admitted to an ICU or a unit with co...

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

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

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

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


...agnostic Test...

...iologic Testing...

...ltures: Outpatient...

...od cultures should NOT be routinely performed in...

...cultures should be obtained in children who fail...

...ltures: Inpatient...

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

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

...ollow-up Blood Cultures...

...cultures in children with clear clinical improveme...

...ultures to document resolution of bactere...

...am Stain and Culture

...mples for culture and Gram stain s...

...Antigen Detection Tests

...ry antigen detection tests are NOT recomme...

...ing For Viral Pathogens...

...e and specific tests for the rapid diag...

...ntibacterial therapy is not necessary for childre...

...or respiratory viruses other than influ...

...sting for Atypical Bac...

...th signs and symptoms suspicious for M. pneumon...

Diagnostic testing for Chlamydophila pn...

...Diagnostic Testing...

Complete Blood Co...

...measurement of the complete blood cou...

...te blood count should be obtained for patie...

...hase Reactants...

...tants such as the erythrocyte sedimentation rate,...

...te phase reactants need not be routinely me...

...ents with more serious disease such as those...

...e Oximetry...

...hould be performed on all children wi...

...hest Radiograp...

...t Radiographs: Outpatient...

...radiographs are not necessary for the...

...s, posteroanterior (PA) and lateral, should be...

...tial Chest Radiographs: Inpatient...

...ographs (PA and lateral) should be perform...

...ollow-up Chest Radiograp...

...t radiographs are not routinely requir...

...repeat chest radiograph should be ob...

...e daily chest radiography is NOT recommended in...

...ow-up chest radiographs should be obtained in p...

...est radiographs 4-6 weeks after the diagno...


...Life-Threatening CAP

...should obtain tracheal aspirates for Gram stain...

...scopic or blind protected specimen brush...


...Complications Associated With CAPHaving...


...ria for Respiratory DistressHaving trouble...


...3. Criteria for CAP Severity of I...


Prevention

Preventi...

...dren should be immunized with vaccines...


...ldren and adolescents 6 months of...


...ts and caretakers of infants less than six mont...


...l CAP following influenza virus infection is d...


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


...le 4. Selection of Antimicrobial Therapy for...


Treatment

...reatment...

...nti-infectiv...

Outpatien...

...ntimicrobial therapy is not routinely required...

...oxicillin should be used as first-li...

...ould be used as first-line therapy for previ...

...acrolide antibiotics should be prescribed for...

...iviral therapy (Table 5) should be admi...

...npatient...

...nicillin G should be administered to th...

...ic therapy with a third generation parent...

...combination therapy with a macrolide (oral...

...mycin or clindmycin (based on local susc...

...nimizing Resis...

...ibiotic exposure selects for antibiotic resistan...

...miting the spectrum of activity of antimicrobials...

...the proper dosage of antimicrobial to be able to...

...he shortest effective duration will minimize...

...of Antimicrobial Therapy...

...s of 10 days have been best studie...

...fections caused by certain pathogens, notably CA...

...ollow-up...

Children on adequate therapy should demon...


...nctive Surgical and Non–Anti-infe...

...rapneumonic Effusion...

...physical examination may be suggestive of parapneu...

...of the effusion is an important factor that det...

...gree of respiratory compromise is a...

...bacterial culture of pleural fluid should...

...testing or nucleic acid amplification throug...

...sis of pleural fluid parameters su...

...nalysis of the pleural fluid white blood cell co...

...ll, uncomplicated parapneumonic ef...

...umonic effusions associated with re...

...horacostomy tube drainage with the addition of...

...S should be performed when there is persi...

...tube can be removed in the absence of an...


...ntibiotic Therapy for Parapneumonic Ef...

...e blood or pleural fluid bacterial c...

...f culture-negative parapneumonic effusions,...

...antibiotic treatment depends on the adequa...

Nonrespon...

...oratory assessment to determine the current s...

...maging evaluation to assess the ext...

...investigation to identify whether the orig...

...should be obtained for Gram stain an...

...rcutaneous lung aspirate should be obtained for Gr...

...psy for Gram stain and culture sho...

...bscess or necrotizing pneumonia identified in...

Discharge Criter...

...nts are eligible for discharge when they have...

...gible for discharge when they demonstrat...

...tients are eligible for discharge only if...

Patients are not eligible for discharge...

...should have documentation that the...

...young children requiring outpatient oral antibio...

...who have had a chest tube and meet the requir...

...s and children with barriers to care...

...tions for Parenteral Outpatient...

...utpatient parenteral antibiotic therapy should...

...nt parenteral antibiotic therapy should be of...

...n to oral outpatient step-down therapy is prefe...


Table 5. Influenza Antiviral Therapy (Please check...


...6. Empiric Therapy for Pediatric CAPHaving trou...


...ctors Associated with Outcomes and Indication for...


...gement of Pneumonia with Parapneumonic E...


...vailable AntibacterialsHaving trouble v...