Management Of Pediatric Community-Acquired Bacterial Pneumonia

Amanda I. Messinger, MD*2. Oren Kupfer, MD*3. Amanda Hurst, PharmD†4. Sarah Parker, MD‡ 1. Divisions of *Pulmonary Medicine and2. ‡Infectious Diseases, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO3. †Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO* Abbreviations: CAP: : community-acquired CT: : computed tomography IV: : intravenous MIC: : minimum inhibitory concentration MRSA: : methicillin-resistant Staphylococcus aureus PCR: : polymerase chain reaction VATS: : video-assisted thorascopic surgeryManagement of pediatric community-acquired pneumonia should focus on judicious use of antimicrobial medications, bacterial diagnostics, and surgical drainage when complicated by large effusion and empyema. Treatment in adherence to national guidelines produces favorable outcomes.After completing this article, readers should be able to:1. Reinforce rational antibiotic use for bacterial community-acquired pneumonia (CAP) in outpatient and inpatient settings.2. Review and update techniques for microbial diagnosis of CAP.3. Review medical and surgical management of complicated pneumonia.4. Present specific considerations for CAP in patients with neuromuscular disease.Community-acquired pneumonia (CAP) is the most common cause of death in children worldwide, accounting for 15% of deaths in children younger than 5 years of age. (1) Nearly 1 in 500 children will be hospitalized for CAP, which creates a substantial economic burden. CAP is thus important to diagnose and appropriately treat. While viral causes of CAP are most common, differentiating viral versus bacterial etiologies can be difficult. This leads to excessive use of antimicrobial medications or susceptibility to feeling a pressure to prescribe. (2) Overall, in the United States, 11.4 million antimicrobial prescriptions for pediatric respiratory tract infections per year are avoidable. (3) Furthermore, broad-spectrum but less effective antimicrobial agents are often prescribed when pharmacokinetically favorable narrow-spectrum agents are available. (4) Arguably, the untoward effects of overtreatment of CAP in those in whom treatment is unwarranted compounds the morbidity of this disease process. Because of mounting knowledge of antimicrobial side effects, resistance, and microbiome effects, practitioners must adhere to the principles of judicious use when treating CAP. In this regard, CAP, its epidemiology, various etiologic origins, clinical presentations, and general diagnosis and treatment were …