- Mar 16th, 2018
- Sean M. Fox
Originally published at Pediatric EM Morsels on February 4, 2017, updated on July 23, 2017. Reposted with permission.
Follow Dr. Sean M. Fox on twitter @PedEMMorsels
Pediatric infectious diseases have been a common topic for the PedEMMorsels and rightfully so as kids love to collect numerous viral and bacterial infections (ex, Measles, Flu, Mumps, Omphalitis). With that being said, pneumonia is often the topic of conversation in the Peds ED and, thus, deserves special attention. We have discussed pneumonia several times previously (ex, Pneumonia Detective, Round Pneumonia, Penicillin for Pneumonia, and CAP), but recently our friends at the Section on Emergency Medicine at the AAP published a easy to follow guide to Community Acquired Pneumonia (displayed below). Let is take another moment to ensure we are up to date with current recommendations for Pediatric Pneumonia.
Pediatric Pneumonia: Basics
- We see a lot of it – accounts for >500,000 ED visits annually!
- Accounts for ~7% of pediatric admissions.
- Streptococcus pneumoniae is the most common bacterial cause of community acquired pneumonia in kids.
- Narrow spectrum beta-lactam antibiotics are still very effective against S. pneumoniae.
- A significant amount of patients (even after published recommendations) continue to receive unnecessary broad spectrum antibiotics as initial therapy! [Ross, 2014]
Pediatric Pneumonia: Management Algorithm
Moral of the Morsel
- Penicillin works well! Most children, even ones who require hospitalization, will benefit from a narrow spectrum penicillin.
- Look for an effusion! The presence of an effusion makes it a more complicated pneumonia and warrants more careful consideration.
- No blood required! The mild and most of the moderate pneumonias will not benefit from extensive blood testing.
Queen MA1, Myers AL, Hall M, Shah SS, Williams DJ, Auger KA, Jerardi KE, Statile AM, Tieder JS. Comparative effectiveness of empiric antibiotics for community-acquired pneumonia.Pediatrics. 2014 Jan;133(1):e23-9. PMID: 24324001. [PubMed] [Read by QxMD]
Leyenaar JK1, Shieh MS, Lagu T, Pekow PS, Lindenauer PK. Comparative effectiveness of ceftriaxone in combination with a macrolide compared with ceftriaxone alone for pediatric patients hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2014 Apr;33(4):387-92. PMID: 24168982. [PubMed] [Read by QxMD]
Ross RK1, Hersh AL, Kronman MP, Newland JG, Metjian TA, Localio AR, Zaoutis TE, Gerber JS. Impact of Infectious Diseases Society of America/Pediatric Infectious Diseases Society guidelines on treatment of community-acquired pneumonia in hospitalized children. Clin Infect Dis. 2014 Mar;58(6):834-8. PMID: 24399088. [PubMed] [Read by QxMD]