• Diagnosis consists of
  • Fever,
  • New onset of symptoms suggestive of LRTI,
  • Parenchymal opacity on chest xray,
  • OR, new or progressive radiographic opacity in a child that has pre-existing pulmonary disease
• Chest xray confirmation recommended
• Consider blood cultures in children requiring hospitalization, prior to starting antibiotics
• Consider rapid influenza testing during influenza season
• If chest tube inserted, send for Gram stain and culture (+/- PCR if on antibiotics)
• Recommend ID consult if poor response to antibiotics, severe disease, unusual organism

• Step down to oral antibiotics when off oxygen, clinically improved, chest tube no longer draining
• Fever can persist and is not a reason to continue parenteral therapy

Antimicrobial Advisory Group (October 2016); Drugs and Therapeutics Committee (February 2017)