Title:Community-Acquired Pneumonia in Children
VOLUME: 12 ISSUE: 2
Author(s):Alexander K.C. Leung*, Alex H.C. Wong and Kam L. Hon
Affiliation:Department of Pediatrics, The University of Calgary, Alberta Children`s Hospital, Calgary, Alberta, Department of Family Medicine, The University of Calgary, Calgary, Alberta, Department of Paediatrics, The Chinese University of Hong Kong, Shatin
Keywords:Amoxicillin, chest infection, cough, fever, respiratory syncytial virus, Streptococcus pneumoniae, tachypnea.
Abstract:Background: Community-acquired pneumonia is an important cause of morbidity in developed
countries and an important cause of morbidity and mortality in developing countries. Prompt diagnosis
and appropriate treatment are very important.
Objective: To provide an update on the evaluation, diagnosis, and treatment of community-acquired
pneumonia in children.
Methods: A PubMed search was completed in Clinical Queries using the key term “communityacquired
pneumonia”. The search strategy included meta-analyses, randomized controlled trials,
clinical trials, observational studies, and reviews. Patents were searched using the key term
“community-acquired pneumonia” from www.google.com/patents, http://espacenet.com, and www.
freepatentsonline.com.
Results: Generally, viruses, notably respiratory syncytial virus, are the most common cause of community-
acquired pneumonia in children younger than 5 years. Streptococcus pneumoniae is the most
common bacterial cause across all age groups. Other important bacterial causes in children younger
than 5 years include Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, and
Moraxella catarrhalis. In children 5 years or older, in addition to S. pneumoniae, other important bacterial
causes include Mycoplasma pneumoniae and Chlamydophila pneumonia. In the majority of cases,
bacterial and viral pneumonia cannot be reliably distinguished from each other on clinical grounds. In
practice, most children with pneumonia are treated empirically with antibiotics; the choice of which
depends on the patient’s age and most likely pathogen. Recent patents related to the management of
community-acquired pneumonia are discussed.
Conclusion: In previously healthy children under the age of 5 years, high dose amoxicillin is the treatment
of choice. For those with type 1 hypersensitivity to penicillin, clindamycin, azithromycin,
clarithromycin, and levofloxacin are reasonable alternatives. For children with a non-type 1 hypersensitivity
to penicillin, cephalosporins such as cefixime, cefprozil, cefdinir, cefpodoxime, and cefuroxime
should be considered. In previously healthy children over the age of 5 years, macrolides such as
azithromycin and clarithromycin are the drugs of choice.
