Pediatric Community Acquired Pneumonia

Pediatric community acquired pneumonia (CAP) is frequently encountered by medical providers and is one of the most common reasons for hospital admission. CAP is known to cause significant morbidity and mortality, causing greater than 2 million deaths annually worldwide in children younger than five years old. The Infectious Disease Society of America (IDSA) released guidelines in 2011 with recommendations regarding appropriate diagnosis and management of community acquired pneumonia for children greater than 3 months age, with the goal of assisting providers in clinical decision making. The guidelines do not recommend routine diagnostic work up for previously healthy, appropriately immunized patients presenting with mild CAP and are otherwise candidates for outpatient treatment. Diagnostic work up indicated for patients presenting with moderate to severe disease include CBC with differential, blood culture, acute phase reactants and chest radiography. Providers may also consider testing for influenza, mycoplasma pneumoniae, and other viral respiratory pathogens depending on the patient's presentation. Antibiotics are not routinely recommended, as the majority of cases are caused by viral pathogens. Narrow spectrum antibiotics are indicated for empiric treatment of bacterial CAP in fully immunized pediatric patients who are not penicillin allergic. Despite these new recommendations, there continues to be delay in changing the methods of practice in some hospitals and clinics. It is important that providers are familiar with the most current guidelines to minimize unnecessary laboratory testing and imaging in the outpatient setting for mild cases, and to use evidence based recommendations for laboratory work up, imaging, and treatment in the inpatient setting.