Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Abstract

Community acquired pneumonia (CAP) is a leading cause of childhood morbidity worldwide. Because of the rising antimicrobial resistance rates and adverse effects of childhood antibiotic use on the developing microbiome, rational prescribing of antibiotics for CAP is important. This review summarizes and critically reflects on the available evidence for the epidemiology, etiology and antimicrobial management of childhood CAP. Larger prospective studies on antimicrobial management derive mostly from low- or middle-income countries as they have the highest burden of CAP. Optimal antimicrobial management depends on the etiology, age, local vaccination policies and resistance patterns. As long as non-rapid surrogate markers are used to distinguish viral- from bacterial pneumonia, the management is probably suboptimal. For a young child with signs of non-severe pneumonia (with or without wheezing), watchful waiting is recommended because of probable viral etiology. For children with more severe CAP with fever, a five-day oral amoxicillin course would be the first choice therapy and dosage will depend on local resistance rates. There is no clear evidence yet for superiority of a macrolide-based regimen for all ages. For cases with CAP requiring hospitalization, several studies have shown that narrow-spectrum IV beta-lactam therapy is as effective as a broad-spectrum cephalosporin therapy. For most severe disease, broad-spectrum therapy with or without a macrolide is suggested. In case of empyema, rapid IV-to-oral switch seems to be equivalent to prolonged IV treatment.

Treatment of Community-Acquired Pneumonia: Are All Countries Treating Children in the Same Way? A Literature Review

“…Since its introduction during the 20th century, antibiotic therapy, along with vaccines, has decreased CAP mortality of 97% in developed countries [ 14 ]. Most of the time the choice of an antimicrobial agent is empirical and based on the most common etiologies for each age group, on the local prevalence of causative organisms, and on the presence of risk factors for atypical or resistant bacteria [ 18 ].…”

Resistance Mechanisms to Antimicrobial Peptides in Gram-Positive Bacteria

“…Streptococcus pneumoniae (pneumococcus) is responsible for around 1 million deaths worldwide every year, and an increasing drug resistance case reporting (Tramper-Stranders, 2018). It is the main causative agent in community acquired bacterial pneumonia, and it can also cause otitis media, conjunctivitis, sinusitis and more severe diseases like meningitis and bacteremia.…”

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

“…All children with signs of pneumonia or severe pneumonia should receive antibiotics (evidence level Ib). [17,101] Adaptation of guidance to address antibiotic resistance Substantial (>80%) reductions in the incidence of invasive pneumococcal disease were observed within 4 years of pneumococcal conjugate vaccine (PCV) introduction. [3] High-dose amoxicillin is effective against pneumococci with low-and intermediate-level penicillin nonsusceptibility causing pneumonia.…”