The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

Abstract

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

Procalcitonin and community-acquired pneumonia (CAP) in children

“…The European and American guidelines [21][22] recommend beta lactam treatment as the first choice in hospitalized children of all ages, to target Streptococcus pneumoniae. In 95% of children with bacterial pneumococcal CAP, apyrexia is reached within 48 h of antibiotic treatment.…”

Pharmacokinetics of Clindamycin in Obese and Nonobese Children

“…Although the current label provides dosing based on BSA as an alternative to dosing by body weight, this is not commonly used in clinical practice. National guidelines for MRSA bone/joint infections and skin and SSTIs (13), community-acquired pneumonia (16), and sinusitis (17) all recommend weight-based clindamycin dosing for children. In post hoc analyses, the OFVs obtained using BSA were higher than those obtained using TBW, so we did not pursue this strategy.…”

Management of Community-Acquired Pneumonia in Hospitalized Children

“…Diagnosis and treatment of the child with a parapneumonic effusion depends on the size of the fluid collection and the degree of respiratory compromise [24]. Small effusions (G10 mm on lateral CXR or G1/4 of the hemi-thorax on CXR) usually resolve with empiric antibiotic therapy and may be monitored clinically if the child appears well.…”

“…Use of these agents is endorsed by the PIDS/IDSA guidelines as well as other national and international health organizations, and is supported by a strong body of evidence [26,24,64,65]. In the post-PIDS/IDSA guidelines era, first-line use of aminopenicillins has increased significantly, but early studies indicate that physicians continue to treat up to 90 % of hospitalized children with broad spectrum cephalosporins [66].…”