pneumonia%20-%20community-acquired%20(pediatric)
PNEUMONIA - COMMUNITY-ACQUIRED (PEDIATRIC)
Community-acquired pneumonia is the presence of signs and symptoms of lower respiratory tract infection acquired outside of the hospital.
The most common bacterial cause of childhood pneumonia is Streptococcus pneumoniae. It usually causes about 1/3 of radiographically-confirmed pneumonia in children <2 years of age.
Viruses commonly affect children <1 year of age than those aged >2 years, respiratory syncytial viruses (RSV) being the most frequently detected virus.
Mixed infection may occur in 8-40% of community-acquired pneumonia cases.

Prevention

Vaccination
  • Children should be given vaccines against bacterial pathogens including S pneumoniae, H influenzae type b, and Bordetella pertussis
  • Pneumococcal conjugate vaccine and combination vaccine against pertussis may be given as early as 6 weeks old and influenza vaccine at 6 months of age as part of the recommended routine immunization schedule
  • Parents and caretakers of infants <6 months of age should be vaccinated against influenza virus and pertussis to protect the infants from exposure to these pathogens
Influenza vaccine1
  • Children ≥6 months of age should be given influenza virus vaccine yearly
  • Two doses separated by a 4-week interval should be administered to children 6 months to 8 years receiving influenza vaccine for the 1st time, then 1 dose yearly after initial dose
Pertussis vaccine1
  • Given as part of the combination vaccine DTaP (diphtheria, tetanus, acellular pertussis) of the recommended routine immunization schedule and with the booster dose Tdap or Td annually for children with complete immunization
Pneumococcal vaccine1
  • Introduction of pneumococcal vaccine greatly reduced the incidence of community-acquired pneumonia (CAP) in children caused by S pneumoniae
  • Pneumococcal 13-valent conjugate vaccine (PCV13) is recommended as a 3-dose series starting at 2 months of age given at 8-week intervals with booster dose given at 12-15 months of age for primary immunization
  • High-risk patients aged ≥2 years should be given pneumococcal 23-valent polysaccharide vaccine (PPSV23) 8 weeks after PCV13 dose
Immunotherapy
  • Respiratory syncytial virus (RSV)-specific monoclonal antibody (eg Palivizumab) may be considered as prophylaxis during RSV season in premature infants and in those with comorbid diseases (eg underlying lung pathology, congenital abnormalities of the airways, hemodynamically significant congenital heart disease, neuromuscular diseases)
Other Preventive Measures
  • Frequent handwashing, breastfeeding, limiting exposure to other children, and reducing exposure to smoking are important measures that should be done
1Recommendations for vaccination may vary between countries. Please refer to local guidelines.

Follow Up

  • Predictors of treatment response are decrease in respiratory signs and defervescence within 48-72 hours of antimicrobial therapy
  • Switch to oral therapy may be considered once there is improvement in fever, cough, tachypnea, supplemental oxygen dependency, and increased activity and appetite, concurrent with decrease in white blood cell (WBC) counts and/or C-reactive protein (CRP) levels
  • Children who developed lobar collapse, round pneumonia, or radiographic findings of CAP complications may have an outpatient follow-up at 6-8 weeks with clinical evaluation and a chest x-ray

Specialist Referral

  • Consultation with a pediatric pulmonologist or infectious diseases specialist is considered if the patient has allergies, other coexisting illnesses or presence of complications (eg effusion, empyema, bronchiectasis, hemolytic uremic syndrome, necrotizing pneumonia, sepsis)
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