Clinical Pearls

Clinical Pearls

New Guidelines for Management of CAP in Children (October 2011)

The Pediatric Infectious Disease Society and Infectious Disease Society of America recently published updated guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in healthy children and infants older than 3 months. If you treat children, consider printing out a copy of these updated guidelines to have handy for reference (see below).  Journal Watch® recently published a synopsis of the guidelines.

* Children who are most likely to require hospitalization for CAP include those with oxygen saturation less than 90%, those with community-acquired MRSA, those unable to adequately feed or comply with treatment, and those between 3 and 6 months.

* Children with CAP should be tested for respiratory viruses, especially influenza. This could decrease antibiotic use and hasten treatment of influenza.

* Children who are well enough to be managed on an outpatient basis do not require chest x-rays or complete blood counts; fully immunized children do not require blood cultures.

* Many pre-school aged children have viral disease and can be treated without antibiotics. If bacterial disease is suspected, amoxicillin is still the mainstay of therapy. A macrolide can be added if an atypical pathogen is suspected.

* Treatment of hospitalized patients may range from amoxicillin/penicillin to vancomycin, clindamycin or ceftriaxone depending on suspicion for various pathogens, local susceptibility patterns and concern for possible MRSA.

* Duration of antibiotic therapy may range from 7-10 days for outpatients and those who respond well to antibiotics. Duration is often longer (2 to 4 weeks) for patients with MRSA or complicated CAP. Change from IV to oral routes when the patient can tolerate it.

* The guidelines offer suggestions for managing CAP with effusions, loculations and abscess formation. See the full guidelines for further information on when surgical consultation may be helpful.

* Routine follow-up chest x-rays are not indicated for children with clinical resolution of their illness and who have no complications.

The guidelines include tables and algorithms to assist with clinical decision-making.

Full text of the guidelines, published August 2011, can be accessed free of charge at:

http://www.ncbi.nlm.nih.gov/pubmed/21880587

Citations:

Bradley, JS et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Disease Society and the Infectious Disease Society of America, Clin Infect Dis 2011 Oct; 53:617.

Journal Watch link to highlights of the guidelines: http://pediatrics.jwatch.org. September 28, 2011 issue. Subscription required.

(WCAPN provides these Clinical Pearls for information only. Each clinical case is different. Please use your clinical judgment and refer to the original publications for complete information as part of your decision-making. WCAPN assumes no liability for the clinician's use of this information in the clinical setting).