Jillian Cotter, MD, MSCS, on recent advances in pediatric pneumonia management

Emerging research in pediatric pneumonia management was highlighted by Jillian Cotter, MD, MSCS, assistant professor at the University of Colorado School of Medicine in Denver, Colorado, during a presentation at the 2025 Pediatric Academic Societies (PAS) Meeting.

"The most emergent evidence that we have over the last five to 10 years has really focused on antibiotic duration for kids with pneumonia," Cotter said. Multiple placebo-controlled randomized trials have shown that shorter antibiotic courses—specifically five days—are noninferior, and in some cases superior, to longer regimens of seven to ten days. Cotter explained, "They see kids reach their clinical response similar times, so fever, duration, resolution of symptoms, and have similar adverse events associated with the antibiotics with fewer days of antibiotic therapy."

Despite most of the robust evidence stemming from outpatient studies, hospitals such as the University of Colorado have extrapolated these findings to the inpatient setting. "We are doing 5 days, and we've updated our internal clinical pathways to recommend 5 days for kids hospitalized with uncomplicated pneumonia, and have had really great adoption from that," Cotter noted.

Diagnostic challenges persist in pediatric pneumonia. Unlike urinary tract infections, where direct bacterial detection is possible, pneumonia lacks a definitive diagnostic test. Cotter commented, "There's no great diagnostic tool to say whether you have pneumonia, yes or no, or whether you have a bacteria or a virus." Tests such as procalcitonin and respiratory viral panels have limitations. Procalcitonin-guided algorithms have produced mixed results and have not seen widespread adoption in pediatric settings. Similarly, respiratory pathogen panels have not significantly altered clinical management due to concerns about co-infection and colonization.

Emerging technologies, including inflammatory marker panels and cell-free DNA sequencing, offer promise but also face limitations. Cell-free DNA assays have shown improved pathogen detection and faster diagnosis, yet specificity remains a concern, complicating the distinction between colonization and true infection.

Antibiotic stewardship remains central to improving outcomes. "Antibiotic stewardship is always thinking about ways to reduce antibiotic exposure to kids," Cotter emphasized. Strategies include prioritizing narrow-spectrum agents, minimizing duration of therapy, and favoring oral over intravenous routes whenever possible to reduce adverse events, maintain gut microbiome integrity, and lower healthcare costs.

As new diagnostic and therapeutic evidence continues to emerge, clinicians must balance evolving research with careful clinical judgment to optimize care for children with pneumonia.

Author Disclosure:

Pfizer Inc (Ongoing) (Products/Services: Research Support, including clinical trials & the principal or named investigator).

Reference:

Cotter J. Putting the 'Pnew' in Pneumonia. Presentation. Presented at: Pediatric Academic Societies 2025 Meeting; April 24-28, 2025. Honolulu, Hawaii.