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

Inpatient (ICU)