Clinical guidelines issued for community-acquired pneumonia management

New clinical practice guidelines issued by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America provide detailed recommendations for prevention, diagnosis, and management of community-acquired pneumonia (CAP) in otherwise healthy infants and children in the outpatient or inpatient setting.

Viral pathogens are responsible for most cases of CAP in children, and according to the guidelines, sensitive and specific tests for rapid diagnosis of influenza virus and other respiratory viruses should be performed. For nontoxic, fully immunized children with CAP managed in the outpatient setting, blood cultures should not be routinely performed. They are recommended, however, for children who do not show clinical improvement or who have progressive symptoms or clinical deterioration after initiation of antibiotics, as well as for children hospitalized with suspected bacterial CAP that is moderate or severe.

Similarly, routine chest radiographs are not necessary for confirmation of suspected CAP in children treated as outpatients, although they are recommended under certain circumstances and for inpatients. Follow-up radiographs are not necessary for children who recover uneventfully.

For situations in which antimicrobial therapy is indicated, the guidelines provide detailed recommendations on the use of specific agents, including dosing and duration of therapy. Recommendations also are provided on adjunctive therapies and management of children who do not respond to treatment.

The guidelines recommend that children be vaccinated against Streptococcus pneumonia and other bacterial pathogens, and they call for annual immunization against influenza virus for infants 6 months of age and older, children, and adolescents, as well as their parents and caretakers.

Bradley JS, Byington CL, Shah SS, et al. Executive summary: 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(7):617-630.

Clarification: The feature article "No Needless Pain: Managing Pediatric Pain in Minor Injuries" (June 2011) has been updated on our Web site and in our interactive digital edition to reflect these changes: The correct dosage for fentanyl injectable solution is 1 mcg/kg (Table, in June isssue), and also on June issue, the correct mixture for buffered lidocaine is 2.7 mL lidocaine with 0.3 mL sodium bicarbonate.