Rana Hamdy, MD, talks diagnosis, treatment of community-acquired pneumonia

At the 2024 American Academy of Pediatrics National Conference & Exhibition, Rana Hamdy, MD, a pediatric infectious diseases physician at Children’s National Hospital in Washington, D.C., provided key insights into the management of community-acquired pneumonia (CAP) in children. Speaking to an audience primarily composed of primary care pediatricians, Hamdy emphasized the importance of incorporating new evidence into clinical practices, even though official guidelines are still based on recommendations published over a decade ago.

“I was honored to be invited by the conference organizers specifically to talk about CAP,” said Hamdy. CAP, she explained, is a common condition encountered by pediatricians in both outpatient and inpatient settings, which makes staying up-to-date with the latest research essential.

“The most recent consensus guidelines for the management of CAP in children published by the IDSA in kids were published in 2011, so it’s been 13 years,” she noted, highlighting the gap between guidelines and current evidence.

“For the diagnosis and management of CAP in preschool-age children, so children under 5 years old, the vast, vast, vast majority of those are viral, and the recommendations remain watchful waiting without antibiotics for those children,” she explained. This approach prevents the unnecessary use of antibiotics, which can lead to resistance. “The prior guidelines from 2011 recommend that X-ray is not necessary to make the diagnosis, and that in the outpatient setting, specifically for mild CAP, that diagnosis can be made clinically,” Hamdy said. However, she acknowledged the difficulty of clinical diagnosis due to overlapping symptoms.

Hamdy also introduced the audience to newer tools for diagnosing CAP, such as the pneumonia risk score, which helps clinicians assess the likelihood of pneumonia. “There are additional clinical tools that have been proven to be superior to just clinician Gestalt in trying to diagnose pneumonia, and one of them is called the Novel Pneumonia Risk Score,” she said. This tool incorporates clinical information such as age, temperature, oxygen saturation, and exam findings to guide next steps in diagnosis and treatment, Hamdy said.

When it comes to antibiotic therapy, Hamdy stated updated research has supported shorter course of treatment.

"[Since 2011], there have been several high quality randomized control trials comparing the duration of antibiotic therapy 5 days compared to 10 days," Hamdy said. "During that 5 days of high dose amoxicillin is just as good as 10 days, and in fact, leads to fewer adverse drug related events and antibiotic resistance with similar clinical outcomes with regard to treatment failure. So really, 5 days should be reflected in updated guidelines, and so even though the 2011 guidelines don't say that, we do have evidence supporting that 5 days is appropriate therapy."

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