Diagnosis and management of pneumonia in children.

BACKGROUND: This paper describes challenges in etiologic diagnosis and treatment of childhood community-acquired pneumonia and the means of addressing some of them. MICROBIOLOGICAL DIAGNOSIS: From about one-third to two-thirds of cases of pneumonia can be attributed to a specific etiology depending on which culture, antigen detection and specialized serologic techniques, some of which are unavailable to clinicians, are used. Results of studies in which microbiologic causes have been sought confirm the importance of Streptococcus pneumoniae as the primary bacterial cause of pneumonia in infants and children. Viral etiologies become less prevalent and mycoplasmal and chlamydial infections become more prevalent with increasing age. EMPIRIC TREATMENT: Because definitive information about causative pathogens is seldom available, treatment of pneumonia is most often empiric. Antibiotic therapy can be withheld in mildly ill, ambulatory patients in whom viral infection is likely. Most guidelines suggest initial treatment with orally administered amoxicillin or amoxicillin/clavulanate or with intravenous cefuroxime when patients require hospitalization. In May, 2000, the Centers for Disease Control-convened Drug-Resistant S. pneumoniae Therapeutic Working Group identified oral beta-lactams including cefuroxime axetil, amoxicillin and amoxicillin/clavulanate as appropriate options for first line therapy of community-acquired pneumonia in ambulatory adults and children.
CONCLUSIONS: New diagnostic techniques such as pneumococcal serologies and polymerase chain reaction testing have improved the ability to determine the microbiologic etiology of childhood pneumonia. Because these tests are not generally available, empiric treatment is necessary. Efforts to identify new intervention strategies, diagnostic tools, therapies and vaccines will be helpful in managing this disease.