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
...Diagnosis and Assessment...
...Site of Car...
...and infants who have moderate to seve...
...ants 3-6 months of age with suspected bacterial C...
...ren and infants with a suspicion or documentation...
...ants for whom there is concern about careful ob...
...Intensive...
...child should be admitted to an intensive c...
...child should be admitted to an IC...
...ld be admitted to an ICU or a unit...
...ld should be admitted to an ICU or a uni...
...ld be admitted to an ICU if pulse oxime...
...child should be admitted to an ICU or a unit...
...ess scores should NOT be used as the sole...
Diag...
...Micro...
...Blood Culture...
...ltures should NOT be routinely performe...
Blood cultures should be obtained i...
...Blo...
...cultures should be obtained in children requiring...
...tients who otherwise meet criteria f...
...Follow-up Blood Cultures...
...cultures in children with clear cl...
...d cultures to document resolution of bacteremia...
...Sputum Gram Stai...
...for culture and Gram stain should be obt...
...Urin...
...ry antigen detection tests are NOT recommended for...
...Testing For Viral Pa...
...ecific tests for the rapid diagnosis of influenz...
...acterial therapy is not necessary f...
...sting for respiratory viruses other t...
...Testing for Aty...
...ith signs and symptoms suspicious for M....
...testing for Chlamydophila pneumoniae is NOT r...
...Ancillary Di...
...Complete...
...surement of the complete blood count is NOT ne...
...plete blood count should be obtained for patients...
...Acute-Phase Reactant...
...actants such as the erythrocyte sedimentation...
Acute phase reactants need not be r...
...n patients with more serious disease such as tho...
...Pulse Oxime...
...ulse oximetry should be performed on all ch...
...Che...
...Initial...
...tine chest radiographs are not nece...
...s, posteroanterior (PA) and lateral, should b...
...Initial Chest Radiogra...
...hest radiographs (PA and lateral) should...
...Follow-up Che...
...at chest radiographs are not routinely required i...
...est radiograph should be obtained in children...
...outine daily chest radiography is NO...
...st radiographs should be obtained in patient...
...epeat chest radiographs 4-6 weeks after th...
...Severe...
...clinician should obtain tracheal aspirates for Gr...
...or blind protected specimen brush sampling, b...
...mplications Associated With CAPHaving tro...
...ria for Respiratory DistressHaving trouble...
...ia for CAP Severity of IllnessaHaving tr...
Prevention
...Prevention...
...en should be immunized with vaccines for bacte...
...children and adolescents 6 months of age and...
...ents and caretakers of infants less than six mo...
...al CAP following influenza virus infec...
...isk infants should be provided immune prophylaxi...
...Selection of Antimicrobial Therapy for Spec...
Treatment
...Treatment...
...Anti-infect...
...Outpatient...
...crobial therapy is not routinely required for pres...
...lin should be used as first-line t...
...n should be used as first-line therapy for previo...
...e antibiotics should be prescribed for treat...
...za antiviral therapy (Table 5) shou...
...Inpatient...
...enicillin G should be administered to the fully...
...herapy with a third generation pare...
...c combination therapy with a macrolide (oral or p...
...indmycin (based on local susceptibi...
...Minimiz...
...ure selects for antibiotic resistance....
...e spectrum of activity of antimicrobia...
Using the proper dosage of antimicrobial...
Treatment for the shortest effective durat...
...Duration of Ant...
...ment courses of 10 days have been best stud...
...sed by certain pathogens, notably CA-MRSA,...
...Follow-up...
...dequate therapy should demonstrate...
...Adjunctive Surgica...
...Parap...
...istory and physical examination may be s...
...the effusion is an important factor t...
...d’s degree of respiratory compromise is...
...in and bacterial culture of pleural flu...
...gen testing or nucleic acid amplification through...
...ral fluid parameters such as pH, glu...
...pleural fluid white blood cell co...
...mall, uncomplicated parapneumonic effusions sh...
...e parapneumonic effusions associated with...
...h chest thoracostomy tube drainage with...
...ld be performed when there is persistence o...
...n be removed in the absence of an intrathoracic...
...Antib...
...od or pleural fluid bacterial culture...
...of culture-negative parapneumonic ef...
...of antibiotic treatment depends on the adequacy o...
...Nonresponse...
...ical and laboratory assessment to d...
...g evaluation to assess the extent and...
...tigation to identify whether the original pa...
...AL specimen should be obtained for...
...s lung aspirate should be obtained f...
...n lung biopsy for Gram stain and culture s...
...abscess or necrotizing pneumonia identifie...
...Discharge Criteria...
...igible for discharge when they have documented...
...re eligible for discharge when they demo...
...ents are eligible for discharge only...
...are not eligible for discharge if...
...atients should have documentation t...
...or infants or young children requiring...
For children who have had a chest tube and meet...
...nfants and children with barriers to care i...
...Indication...
...parenteral antibiotic therapy shou...
...arenteral antibiotic therapy should be o...
...oral outpatient step-down therapy is preferred,...
...nza Antiviral Therapy (Please check the...
...Therapy for Pediatric CAPHaving troubl...
...ctors Associated with Outcomes and Indication f...
Figure 1. Management of Pneumonia with Parapne...
...ilable AntibacterialsHaving trouble viewing...