Community-acquired pneumonia in children: Outpatient treatment
- William J Barson, MD
William J Barson, MD
- Professor of Pediatrics
- The Ohio State University College of Medicine
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- George B Mallory, MD
George B Mallory, MD
- Section Editor — Pediatric Pulmonology
- Associate Professor of Pediatrics
- Baylor College of Medicine
Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia. CAP is a common and potentially serious illness with considerable morbidity.
The Pediatric Infectious Diseases Society/Infectious Diseases Society of America and the British Thoracic Society have developed clinical practice guidelines for the evaluation and treatment of CAP in children [1,2].
The outpatient treatment of CAP in infants and children will be reviewed here. Neonatal pneumonia and inpatient treatment of pneumonia are discussed separately, as are the epidemiology, etiology, clinical features, and diagnosis. (See "Neonatal pneumonia" and "Pneumonia in children: Inpatient treatment" and "Pneumonia in children: Epidemiology, pathogenesis, and etiology" and "Community-acquired pneumonia in children: Clinical features and diagnosis".)
INDICATIONS FOR HOSPITALIZATION
The decision to hospitalize a child with CAP is individualized based upon age, underlying medical problems, and clinical factors including severity of illness (table 1) [1-3]. Hospitalization generally is warranted for infants younger than three to six months of age, unless a viral etiology or Chlamydia trachomatis is suspected and they are normoxemic and relatively asymptomatic. Hospitalization is also warranted for a child of any age whose family cannot provide appropriate care and assure compliance with the therapeutic regimen. Additional indications for hospitalization include [1,2]:
●Hypoxemia (oxygen saturation <90 percent in room air at sea level)
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- INDICATIONS FOR HOSPITALIZATION
- EMPIRIC THERAPY
- Children <5 years
- - Neonates
- - One to six months
- - Six months to five years
- Suspected viral etiology
- Suspected bacterial etiology
- Suspected atypical pneumonia
- Children ≥5 years
- - Suspected typical or atypical bacterial etiology
- - Suspected influenza
- Suspected aspiration pneumonia
- Monitoring response
- - Treatment failure
- Worsened condition
- Failure to improve
- SUPPORTIVE CARE
- Clinical course
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS