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 Asse...

...re Management Decisions...

Hospita...

...fants who have moderate to severe CAP2 as define...

...months of age with suspected bacte...

...infants with a suspicion or docume...

...ldren and infants for whom there is concern ab...

...ive Care Unit...

...d be admitted to an intensive care unit (ICU) if...

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

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

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

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

...hould be admitted to an ICU or a u...

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


Diagnostic Testi...

...crobiologic Testing...

...ltures: Outpatient...

...res should NOT be routinely performed...

...s should be obtained in children who...

...ultures: Inpatient...

...tures should be obtained in children re...

...ving patients who otherwise meet criteria...

...ow-up Blood Culture...

...od cultures in children with clear clinical i...

...blood cultures to document resolution of bact...

...um Gram Stain and Culture...

...samples for culture and Gram stain should be obt...

...y Antigen Detection Tests...

...igen detection tests are NOT recommended...

...sting For Viral Pathogens...

...tive and specific tests for the rapid diagnosis...

Antibacterial therapy is not necessary for...

...ng for respiratory viruses other than i...

...or Atypical Bacteria...

...n with signs and symptoms suspicious f...

...ng for Chlamydophila pneumoniae is NOT recommended...

...y Diagnostic Testing...

...lete Blood Count...

...measurement of the complete blood count is...

...complete blood count should be obtained for...

...te-Phase Reactants...

...actants such as the erythrocyte sedim...

...tants need not be routinely measured in f...

...n patients with more serious disease such as tho...

...ulse Oximetry...

...oximetry should be performed on all chil...

Chest Radiography

...t Radiographs: Outpatient...

...t radiographs are not necessary for the co...

...phs, posteroanterior (PA) and lateral, shou...

...nitial Chest Radiographs: Inpatien...

Chest radiographs (PA and lateral) s...

...p Chest Radiograph...

...iographs are not routinely required in c...

...radiograph should be obtained in children who...

...utine daily chest radiography is N...

...t radiographs should be obtained in pati...

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


...or Life-Threatening CAP...

...inician should obtain tracheal aspirates for Gram...

...c or blind protected specimen brush sampling,...


...Complications Associated With CAPHaving...


...eria for Respiratory DistressHavin...


...3. Criteria for CAP Severity of Illne...


Prevention

...vention...

...should be immunized with vaccines fo...


...nd adolescents 6 months of age and older...


...ts and caretakers of infants less...


...eumococcal CAP following influenza virus i...


...h-risk infants should be provided imm...


...on of Antimicrobial Therapy for Spe...


Treatment

...reatme...

...-infective

Outpatient

...herapy is not routinely required for pres...

...hould be used as first-line therap...

Amoxicillin should be used as first-line thera...

...iotics should be prescribed for treat...

...za antiviral therapy (Table 5) should be ad...

...atient

...mpicillin or penicillin G should be ad...

Empiric therapy with a third generatio...

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

...clindmycin (based on local susceptibility d...

...izing Resistanc...

...exposure selects for antibiotic resistance. Th...

...pectrum of activity of antimicrobials to th...

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

...t for the shortest effective duration will minim...

...of Antimicrobial Therap...

...ent courses of 10 days have been best stud...

Infections caused by certain pathogens, notably...

...llow-up...

...adequate therapy should demonstrate cli...


...rgical and Non–Anti-infective Therapy...

...umonic Effusion...

...ry and physical examination may be suggestive of...

...e effusion is an important factor t...

...child’s degree of respiratory comprom...

...n and bacterial culture of pleural fluid...

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

...ral fluid parameters such as pH, glucose, pro...

...pleural fluid white blood cell count, with ce...

...mall, uncomplicated parapneumonic effusions shou...

...ate parapneumonic effusions associated with resp...

...oth chest thoracostomy tube drainage wit...

...performed when there is persistence of moderate-...

...t tube can be removed in the absence of a...


...tibiotic Therapy for Parapneumonic Effu...

...en the blood or pleural fluid bacteri...

...n the case of culture-negative parapneumoni...

...antibiotic treatment depends on the adequac...

Nonrespo...

...and laboratory assessment to determine the curre...

...maging evaluation to assess the extent and...

...er investigation to identify whether...

...BAL specimen should be obtained for Gra...

...ercutaneous lung aspirate should be...

...pen lung biopsy for Gram stain and cultu...

...y abscess or necrotizing pneumonia...

...charge Criter...

...ligible for discharge when they have documente...

...eligible for discharge when they...

...ligible for discharge only if they demonstrate...

...not eligible for discharge if they have substan...

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

...ts or young children requiring outp...

...ildren who have had a chest tube an...

...and children with barriers to car...

...Parenteral Outpatient Therapy...

...tient parenteral antibiotic therapy should be...

...parenteral antibiotic therapy should...

...oral outpatient step-down therapy...


...e 5. Influenza Antiviral Therapy (Pl...


...e 6. Empiric Therapy for Pediatric C...


...tors Associated with Outcomes and Indication for D...


...gure 1. Management of Pneumonia with...


...vailable AntibacterialsHaving trouble...