Community-acquired pneumonia in children: A look at the IDSA guidelines

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Applied Evidence

Community-acquired pneumonia in children: A look at the IDSA guidelines

J Fam Pract. 2013 January;62(1):9-15

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References

1. Bradley JS, Byington CL, Shah SS, et al. 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. Clin Infect Dis. 2011;53:e25-e76.Available at: http://cid.oxfordjournals.org/content/53/7/e25.long. Accessed December 17, 2012.

2. Centers for Disease Control and Prevention Pneumonia Can Be Prevented–Vaccines Can Help. Available at: http://www.cdc.gov/features/pneumonia. Accessed January 17, 2012.

3. Bulla A, Hitze KL. Acute respiratory infections: a review. Bull World Health Organ. 1978;56:481-498.

4. Baqui AH, Black RE, Arifeen SE, et al. Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study. Bull World Health Organ. 1998;76:161-171.

5. Murphy SL, Xu JQ, Kochanek KD. Deaths: Preliminary data for 2010. National vital statistics reports; vol 60 no 4. Hyattsville, Md: National Center for Health Statistics. 2012. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf. Accessed May 12, 2012.

6. Clinical management of acute respiratory infections in children: a WHO memorandum. Bull World Health Organ. 1981;59:707-716.

7. Feldman C, Anderson R. Community-acquired pneumonia. In; Bone RC, Dantzker DR, George RB, et al, eds. Pulmonary and Critical Care Medicine. Vol 2. St. Louis, Mo: Mosby-Year Book, Inc; 1997:719–733.

8. Davies HD. Community-acquired pneumonia in children. Paediatr Child Health. 2003;8:616-619.

9. Alexander ER, Foy HM, Kenny GE, et al. Pneumonia due to Mycoplasma pneumoniae. Its incidence in the membership of a co-operative medical group. N Engl J Med. 1966;275:131-136.

10. Foy HM, Cooney MK, Maletzky AJ, et al. Incidence and etiology of pneumonia, croup and bronchiolitis in preschool children belonging to a prepaid medical group over a four-year period. Am J Epidemiol. 1973;97:80-92.

11. Murphy TF, Henderson FW, Clyde WA, Jr, et al. Pneumonia: An eleven-year study in a pediatric practice. Am J Epidemiol. 1981;113:12-21.

12. Denny FW, Clyde WA. Acute lower respiratory tract infections in non-hospitalized children. J Pediatr. 1986;108:635-646.

13. Ostapchuk M, Roberts DM, Haddy R. Community-acquired pneumonia in infants and children. Am Fam Phys. 2004;70:899-908.

14. Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA. 1998;279:308-313.

15. Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66 (suppl 2):ii1-ii23.

16. Gaston B. Pneumonia. Pediatr Rev. 2002;23:132-140.

17. McIntosh K. Community-acquired pneumonia in children. N Engl J Med. 2002;346:429-437.

18. Skolnik N, Tien P. Managing community-acquired pneumonia in infants and children. Fam Pract News. November 10, 2011. Available at: http://www.familypracticenews.com/views/clinical-guidelines-for-family-physicians-by-dr-skolnik/blog/managing-community-acquired-pneumonia-in-infants-and-children/3a77ebb81a.html. Accessed January 17, 2012.

19. O’Mara N. Empiric treatment for pediatric community-acquired pneumonia. Pharmacist’s Letter. November 2011. Available at: http://www.pharmacistletter.com. Accessed February 25, 2012.

20. Klein JO. Bacterial pneumonias. In: Cherry J, Kaplan S, Demmler-Harrison G, eds. Feigin & Cherry’s Textbook of Pediatric Infectious Diseases. 6th ed. Vol 1. Philadelphia, Pa: Saunders/Elsevier; 2009:302–314.

21. Morita JY, Kahn E, Thompson T, et al. Impact of azithromycin on oropharyngeal carriage of group A Streptococcus and nasopharyngeal carriage of macrolide-resistant Streptococcus pneumoniae. Pediatr Infect Dis J. 2000;19:41-46.

22. Block S, Hedrick J, Hammerschlag MR, et al. Mycoplasma pneumoniae and Chlamydia pneumoniae in pediatric community-acquired pneumonia: comparative efficacy and safety of clarithromycin vs. erythromycin ethylsuccinate. Pediatr Infect Dis J. 1995;14:471-477.

23. Harris JA, Kolokathis A, Campbell M, et al. Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J. 1998;17:865-871.

24. Pallares R, Capdevila O, Linares J, et al. The effect of cephalosporin resistance on mortality in adult patients with nonmeningeal systemic pneumococcal infections. Am J Med. 2002;113:120-126.

25. Roson B, Carratala J, Tubau F, et al. Usefulness of betalactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone. Microb Drug Resist. 2001;7:85-96.

26. Miller LG, Kaplan SL. Staphylococcus aureus: a community pathogen. Infect Dis Clin North Am. 2009;23:35-52.

27. Haider BA, Saeed MA, Bhutta ZA. Short-course versus long-course antibiotic therapy for non-severe community-acquired pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2008;(2):CD005976.-

28. Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis. 2004;38:1651-1672.

29. Bradley JS, Ching DK, Hart CL. Invasive bacterial disease in childhood: efficacy of oral antibiotic therapy following short course parenteral therapy in non-central nervous system infections. Pediatr Infect Dis J. 1987;6:821-825.

30. Blaschke AJ, Heyrend C, Byington CL, et al. Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema. Pediatr Infect Dis J. 2011;30:289-294.

31. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Revised indications for the use of palivizumab and RSV immune globulin intravenous for the prevention of respiratory syncytial virus infection. Pediatrics. 2003;112:1442-1446.

If S aureus is the suspected microorganism or is confirmed with clinical, laboratory, or imaging characteristics, give vancomycin or clindamycin with a beta-lactam agent.^1,25-26 If you suspect an atypical pathogen such as M pneumoniae or C pneumoniae, start empiric therapy with an oral or parenteral macrolide in combination with a beta-lactam.¹

Once a pathogen has been identified, adjust antimicrobial therapy as needed to target the specific microbe, to limit empiric antibiotic exposure, and to help limit the potential for antibiotic resistance.

Duration of treatment. The recommended duration of treatment for CAP is 10 days, supported by clinical data and the practice guidelines.^1,27-29 Shorter treatment courses may be effective, especially in mild cases or outpatient treatment.¹ Specific pathogens, such as MRSA, may need to be treated longer.³⁰

FAST TRACK

The recommended duration of treatment for CAP is 10 days.

If a patient is receiving intravenous antibiotics, switch to an oral agent as soon as clinically feasible to decrease risks from parenteral administration, and plan for the earliest possible discharge from the hospital to limit exposure to nosocomial pathogens. Hospital discharge may be considered when a child is clinically stable (improved appetite and activity level, afebrile for 24 hours), mental status is back to baseline or stable, and the pulse oximetry level is >90% on room air for at least 24 hours.¹

Children receiving adequate therapy regimens should demonstrate both clinical and laboratory signs of improvement within 48 to 72 hours.¹ If improvement does not occur, further your investigation with additional cultures, laboratory tests, and imaging evaluation.

For preventive measures, the guidelines recommend properly immunizing children with vaccines for bacterial pathogens such as S pneumoniae, Haemophilus influenzae, and Bordetella pertussis.¹ Influenza vaccine should also be offered to prevent CAP in infants and children 6 months of age and older. Offer influenza and pertussis vaccines to adults and those caring for infants and children, to help prevent the spread of disease. Also consider immune prophylaxis with RSV-specific monoclonal antibody for premature infants or those with bronchopulmonary dysplasia, congenital heart disease, or immunodeficiency, to decrease the risk of severe pneumonia and hospitalization. For detailed recommendations on the use of prophylaxis against RSV, refer to the 2003 American Academy of Pediatrics statement.³¹

CORRESPONDENCE
Stephanie Schauner, PharmD, BCPS, University of Missouri-Kansas City, Health Science Building, Room 2241, 2464 Charlotte Street, Kansas City, MO 64108-2792; schauners@umkc.edu