Management of community-acquired pneumonia in children.

Community-acquired pneumonia (CAP) is a significant cause of childhood morbidity and mortality worldwide. Viral etiology is most common in young children and decreases with age. Streptococcus pneumoniae is the single most common bacterial cause across all age groups. Atypical organisms present similarly across all age groups and may be more common than previously recognized.A bacterial pneumonia should be considered in children presenting with fever >38.5 degrees C, tachypnea, and chest recession. Oxygen therapy is life saving and should be given when oxygen saturation is <92%. For non-severe pneumonia, oral amoxicillin is the antibacterial of choice with low failure rates reported. Severely ill children are traditionally treated with parenteral antibacterials. Penicillin non-susceptible S. pneumoniae prevalence rates are increasing and have been linked to community antibacterial prescribing. Most pneumococci remain sensitive to high-dose penicillin-based antibacterials but macrolide resistance is also a problem in some communities. However, primary combination treatment with macrolides is indicated in areas where there is a high prevalence of atypical organisms. The most common complications in CAP are parapneumonic effusions and empyema. The use of ultrasonography combined with intercostal drainage augmented with the use of fibrinolytic therapy has significantly reduced the morbidity associated with these complications. There is increasing evidence that a preventative strategy with the 7-valent pneumococcal conjugate vaccine (PCV-7) results in a significant fall in CAP in early childhood.