Materials for this week
A few take home points to review:
- What is the global burden of pneumonia? The WHO reports pneumonia is the single highest cause of death in children worldwide under 5, accounting for 18% of deaths. Fortunately it has become much less of a problem for us in an era of widespread access to vaccines against pneumococcal and HIB. In the US, pneumonia occurs in an estimated ~2.6% of children under age 17.
- How do we diagnose pneumonia? Pneumonia is a clinical diagnosis that can be challenging to confirm, and no single definition is used in pediatrics. In diagnosing it, we look for the most common symptoms of cough, fever, and/or tachypnea in the setting of findings of parenchymal disease by either physical exam or chest x-ray. Crackles (rales) are the most common exam finding, but we should also look for decreased breath sounds, egophany, tactile fremitus, and/or dullness to percussion. X-rays are not needed to confirm diagnosis or resolution of pneumonia, but should be obtained when diagnosis is less certain and/or patient symptoms are more severe. Labs such as blood cultures are not routinely indicated for children treated as outpatients.
- What is the recommended treatment? Treatment is based on age and severity. Viral pneumonia is much more common in preschool age children, so observation and supportive care is often appropriate. Older children are more likely to have bacterial pneumonia and are treated as appropriate with high-dose amoxicillin as first line therapy for lobar disease. Use azithromycin for suspected atypical pneumonia, or both amox and a macrolide, especially if they are sicker.
- Who can be managed as an outpatient? Outpatient management of pneumonia is appropriate for mild-to-moderate disease for children who are not hypoxic or in distress who can tolerate oral antibiotics. The Pediatric Infectious Diseases Society guidelines recommend hospitalization for children with moderate to severe CAP including respiratory distress and/or hypoxemia (pulse ox <= 90%).