PEDIATRIC COMMUNITY-ACQUIRED PNEUMONIA CLINICAL GUIDELINE

Guideline Eligibility Criteria: Assessment: Respiratory status (rate for age,

 Age 3 months to 17 years WOB, crackles, decreased or abnormal breath
 Previously healthy children with no underlying conditions sounds), AMS, apnea, pulse ox < 90% on room
 Clinical findings of CAP air, Immunization Status (DTaP, Pneumoccocal,
influenza, HiB), Exposure to TB
Guideline Exclusion:
 Aspiration Intervention: oxygen to keep sats >92%, IVF if
 Immunocompromised children clinically indicated.
 Recent hospitalization (<7days before the onset of
illness)
 Underlying lung disease or other chronic condition *Tachypnea*
Meets inpatient criteria: Age 0-2mo: >60
Age 2-12mo: >50
Outpatient Management O2 sats < 90% Age 1-5 yrs: >40
Influenza: oseltamivir (or NO Not tolerating PO Age >5 yrs: >20
zanamivir for children ≥7) Age 3 to 6 mo
Presumed bacterial: Respiratory distress WHO Criteria for severe illness
Not able to drink
 Preferred: amoxicillin
persistent vomiting
(Alternative: augmentin) YES convulsions
 PCN allergic: CTX, cefotaxime, lethargic or unconscious
or clindamycin Severely ill? stridor in a calm child
Presumed atypical: Azithromycin
NO YES
>5years old: Consider empiric
Inpatient Management:
addition of azithromycin
Severe or concern for Complicated CAP
Repeat CXR in 4-6 wks if concern Inpatient Management:  CXR at admission
for lung collapse to r/o mass, Uncomplicated CAP  Labs to consider: Flu/RSV if <3yrs, Flu if >3
anatomic anomaly  CXR at admission yrs, (RVP only if Flu/RSV negative), Blood culture
 No labs required x1, CRP/ESR (only to trend improvement)
 Start therapy  CBC is not helpful in trending disease or
determining viral vs bacterial cause
 Start therapy

ANTI-MICROBIAL THERAPY
Continued Considerations Immunized
 D/c antibiotics if RVP positive  Ampicillin or penicillin G
 D/c IVF when tolerating PO  Alternatives (PCN allergic): ceftriaxone, cefotaxime, clindamycin
 Change to oral antibiotics upon Not Fully Immunized for H. flu and S. pneumo
clinical improvement  Ceftriaxone or cefotaxime
 Repeat CXR if no clinical Resistant organism
improvement in 48 to 72 hrs
 Ceftriaxone 100 mg/kg/day divided q12-24h
Discharge Criteria **Add macrolide only if M. pneumonia or C. pneumonia are
 Tolerating PO significant considerations
 No supplemental O2 for 12-24h
 Respiratory rate normal for age **Start oseltamivir if influenza + or if high suspicion for influenza
even if test negative

If severely Ill consider:

 Empiric influenza treatment
Created 6/2015. Based on IDSA CAP guidelines 2011.
 CA-MRSA, add vancomycin or clindamycin
Temp>39? WBC >15,00Suspician for CA-MRSA?