Pediatric Pneumonia Tips

http://www.medscape.org/viewarticle/749312
http://www.medscape.com/viewarticle/752596

Recently in August 2011, the Infectious Disease Society of America (IDSA) composed its first ever expert opinion guidelines on pediatric community acquired pneumonia (CAP). We all have been well versed in this group's adult community acquired pneumonia guidelines (the usual Levaquin or the combo of Rocephin and Zithromax), but little guidance has been given for pediatrics.
Please note that for all you evidence based medicine fans (Is that an oxymoron?) the IDSA admits to a relative paucity of studies in the area of pediatric community acquired pneumonia. After all, it is hard to get a randomized trial going, let alone a meta-analysis, of kids with respiratory distress and pneumonia. Still, a broad ranged panel of 13 experts sifted through the data and came up with the guidelines above. Both of the Medscape articles are summary articles, while the end IDSA link is the full 52 page document for all you OCD providers (like myself and Dr. Chao).
Here is a rough sumary, but I do encourage people to check out the fairly succinct first link above- #749312.

Point 1: For preschool and school aged children who have been previously healthy and IMMUNIZED, the recommended first line agent is (believe it or not) amoxicillin. The ID experts cite the extreme success of the previous Prevnar 7, and now the newer Prevnar 13, against the real "bad boy" resistant Strep. pneumoniae that previously wreaked havoc on pediatric workups. REMEMBER- immunization is crucial to this guideline!

Point 2: Don't forget macrolides (good ol' "Vitamin Z"-Zithromax) for MAINLY school aged children who have clinical histories consistent with atypical pneumonia.

Point 3: Don't forget antivirals for confirmed pneumonia with flu-like histories.

Point 4: The IDSA guidelines bluntly suggest for all children with suspected pneumonia aged 3-6 months old, hospitalization should be done. The experts cite the vulnerability of this age group to encapsulated bacteria like Strep pneumoniae, and the lack of full immunization at this age.

Point 5: For amoxicillin failures, don't forget CA-MRSA as a potential pathogen. I would be interested in comments on this matter, as the IDSA always suggests CA-MRSA pneumonia needs vancomycin, but does anyone know if Bactrim has the needed respiratory/lung penetration to treat lung infections? Just food for thought...

Lastly, we all realize the challenge with pediatric guidelines is not the credibility of the science per se, but instead getting the parents on board. Still, I hope this update lets you practice with more confidence and awareness.

Here is the full IDSA paper:
http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2011%20CAP%20in%20Children.pdf