SHM's Clinical Quick Talks-Pediatric Community Acquired Pneumonia (CAP)

Pdf Summary
Community-acquired pneumonia (CAP) in children and adolescents can be diagnosed based on clinical symptoms such as fever, cough, and rapid breathing. Physical examination findings may include localized rales/rhonchi or decreased breath sounds. Occult pneumonia, without physical examination findings, may be the source of fever in preschool children. Wheezing is not consistent with a bacterial infection. Routine laboratory tests such as complete blood count (CBC), blood culture, and sputum culture are not necessary if CAP is clinically suspected. Influenza testing can be done during flu season. Mycoplasma testing is not sensitive or specific enough to confirm the diagnosis of pneumonia. <br /><br />Routine chest x-ray is not necessary if CAP is clinically suspected, although a negative x-ray does not rule out pneumonia since it may lag behind the clinical presentation. More tests such as CBC and blood culture may be done for severe illness or suspicion of complicated pneumonia. Indications for admission include hypoxia, moderate to severe respiratory distress, inability to tolerate oral intake, complicated pneumonia, and children below 6 months of age. Children who can tolerate oral intake, are not hypoxic, and do not have respiratory distress can be treated as outpatients. <br /><br />Treatment of CAP involves age-dependent antibiotic therapy. For children aged 2 months to 2 years, supportive care may be sufficient if the likelihood of bacterial infection is low. Antibiotics should cover Streptococcus pneumoniae, such as amoxicillin orally or ampicillin intravenously. Ceftriaxone intramuscularly can be used for poor oral intake or lack of intravenous access. For sicker children or those with evidence of abscess or pneumatocele, staphylococcal coverage may be added. For children aged 2-5 years, amoxicillin or ampicillin can be used since streptococcal infections are more common in this age group. Macrolides should generally not be used due to streptococcal resistance unless susceptibility is known. In case of penicillin allergy, first-generation cephalosporins or clindamycin can be considered. <br /><br />Chest physiotherapy is not recommended. Follow-up labs and repeat chest x-rays are not necessary unless there is lack of improvement or worsening. Complications of CAP include viral etiology, which does not require antibiotics, and parapneumonic effusions. Drainage of effusions may improve fever but is not always necessary if the patient is stable or improving. Consultations may be sought for procedures such as drainage or removal of foreign bodies, and for management of unusual organisms or recurrent pneumonia. Discharge criteria include stability on room air and tolerating oral intake to complete a 10-day course of antibiotics.
Asset Subtitle
Elizabeth A. Cerceo
Keywords
Community-acquired pneumonia
CAP
children
diagnosis
clinical symptoms
fever
antibiotic therapy
chest x-ray
complications
discharge criteria