Guidelines
Pediatric: Community Acquired Pneumonia

Pediatric: Community Acquired Pneumonia

Risk Factors

  • Mechanical ventilation with noninvasive positive pressure ventilation
  • Septic shock requiring vasopressors (fluid refractory shock)
  • Pulse oximetry of ≤90% on room air
  • Hypoxia requiring FiO2 greater than inspired concentration or flow feasible in general care area

ICU Admission for Children:

  • Respiratory rate higher than WHO classification for age, Pa)2/Fi02 ≤250, Apnea
  • PEWS score >6, confusion, hypotension, unexplained acidosis
  • Multilobar infiltrates, presence of effusion
  • Increased work of breathing (eg, retractions, dyspnea, nasal flaring, grunting)
  • Unexplained Acidosis
  • Comorbid conditions (HgbSS, immunosuppression, immunodeficiency)
  • Respiratory Distress Defined:
    • Tachypnea, respiratory rate, breaths/min
      • Age 0–2 months: >60
      • Age 2–12 months: >50
      • Age 1–5 Years: >40
      • Age >5 Years: >20
  • Age: Greater than 65 years or less than 2 years (may be less than 5 years)
  • Prior hospitalization (Children)
  • Aspiration pneumonia with previous episodes of pneumonia in the last year (children)
  • B-lactam within past 3 months (fluoroquinolones (FQ)/macrolides increase resistance as well)
  • Immunosuppressive illness (including treatment with corticosteroids)
  • Multiple medical comorbidities: DM, CRI, CHF, CAD, malignancy, chronic hepatic disease
  • Exposure to child in day care center
  • Unimmunized or under immunized
  • Prior antibiotic therapy (especially with FQ)
  • End-stage renal disease
  • Prior influenza
  • ICU admission (children)
  • Necrotizing or cavitary infiltrates (children)
  • Empyema (children)
  • Recent antibiotic therapy
  • Tracheostomy
  • Multiple medical comorbidities
  • Underlying cardiopulmonary disease
  • Structural lung disease (bronchiectasis, CF, CP + chronic aspiration)
  • Corticosteroid therapy (>10 mg prednisone/day)
  • Antibiotic therapy for >7 days in past month
  • Malnutrition

Outpatient (ED) ≤5 Year of age

Inpatient (ICU)