>Clinical Practice Pediatric Pneumonia
Urgent Care Focused Guideline Highlights
The following is a highlight of a guideline from another group reviewed by Urgent Care physicians. Our intent is to assure these highlights represent the actual intent of these articles and how they relates to the practice of urgent care medicine. These highlights are not intended to substitute for independent medical judgement nor are they intended to establish a standard of care. UCCOP recommends at minimum reading those portions of this article that relate to the scope of care you provide.
Pediatric Community Pneumonia Guidelines
Published August 8, 2011
Synopsis by Sean Mcneeley, MD and Lee Resnick, MD
Bradley, J. S. Et al (2011). 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. Clinical Infectious Diseases, Oct53(7):e25-76. Epub 2011 Aug 31. Full article can be found here.
- Admission suggested if under 6 months, respiratory distress or hypoxia or concerns for home care (strong recommendation, variable evidence)
- Blood culture should not be performed in nontoxic, fully immunized children with CAP (strong recommendation, moderate quality evidence)
- Sensitive and specific viral tests should be used to decide if antibiotics are unnecessary or antivirals indicated (strong recommendation, high-quality evidence)
- Routine CBC measurements in not necessary in CAP except in patients with severe pneumonia (weak recommendation, Low-quality evidence
- Routine chest radiographs are not necessary in patients well enough to be treated in outpatient setting (strong recommendation, high-quality evidence)
- Repeat chest radiographs are not routinely needed (strong recommendation, moderate-quality evidence)
- Amoxicillin should be used as first line therapy in previously healthy, immunized infants and preschoolers with mild to moderate pneumonia (strong recommendation, moderate-quality evidence)
- Amoxicillin (or macrolide antibiotics if evidence of atypical disease) should be the first line therapy in older children who were previously healthy and fully immunized. (strong recommendation, moderate-quality evidence)
- Treatment courses of ten days have been best studied and are adequate (strong recommendation, moderate-quality evidence)
- Clinical improvement should be expected within 48-72 hours and if improvement is not noted in this timeframe further investigation should be performed. (strong recommendation, moderate-quality evidence)
- Pneumococcus is noted to have significant resistance rates to Macrolides and Cephalosporins (30-40% of strains are resistant). For those children with a history of nonserious allergic reaction to Amoxicillin, options include: A trial of Amoxicillin under close supervision or a trial of extended spectrum cephalosporin with monitoring for response. Macrolides should not be used alone unless no other options exist or if the patient's age and diagnostic findings are consistent with atypical pneumonia."
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