Management of Community-Acquired Pneumonia in Hospitalized Children

Abstract

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization in US children despite a decrease in the prevalence of disease resulting from widespread use of pneumococcal conjugate vaccines. Diagnostic testing should be limited to children hospitalized with moderate to severe disease, which is characterized by hypoxemia, respiratory distress, and/or sepsis. At a minimum, these children should have blood cultures and chest radiographs (CXRs) performed. Viral testing should also be performed during influenza season or in other scenarios where viral identification may reduce antibiotic use. Fully immunized children should be treated empirically with narrow-spectrum aminopenicillins, and amoxicillin is usually the best choice for empiric step-down oral therapy. The benefit of using macrolide antibiotics for suspected Mycoplasma pneumoniae remains unclear. These agents may be most beneficial for older children. Pneumonia complication rates are increasing, and children who fail to improve after 48--72 h should be re-evaluated for treatment failure and complicated pneumonia, which may require further imaging, chest tube placement, or video-assisted thoracoscopic surgery (VATS). Children with complicated pneumonia require a prolonged duration of antibiotic therapy.