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?