Community Acquired Pneumonia in ( CAP ) in Children ( >4 weeks old - <16 years age ) - Guidance for the management of
|Publication: 12/12/2012 --|
|Last review: 01/02/2018|
|Next review: 01/02/2021|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2018|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guideline for management of community acquired pneumonia (CAP) in children (>4 weeks old-<16 years of age)
Community Acquired Pneumonia in ( CAP ) in Children ( >4 weeks old - <16 years age )
Follow up CXR is not required in those who are previously healthy and who are recovering well but should be arranged, with clinical review, for those with a round pneumonia, collapse or persisting symptoms.
Perform pulse oximetry - all children with CAP.
Consider a CXR in children admitted to hospital with pneumonia. However, a CXR should not be considered a routine investigation in those thought to have community acquired pneumonia. Children with mild pneumonia who can be managed in the community do not routinely need a CXR. A lateral CXR should not be performed routinely.
Blood tests are not routinely needed but can be requested if felt to be clinically indicated. If IV fluids are needed, check U+E at baseline and at least daily. CRP is not useful in the management of pneumonia and should not be tested routinely.
Microbiological investigations are not routinely needed in those with milder disease.
Microbiological investigations are recommended in those with severe pneumonia sufficient to require PICU admission, or in those with complications. Investigations should include:
Blood culture, viral NPA or nasal swabs, acute and convalescent serology for respiratory viruses, Mycoplasma and Chlamydia. If present, pleural fluid should be sent for microscopy, culture, pneumococcal antigen detection and/or PCR.
|Empirical Antimicrobial Treatment|
|Directed Antimicrobial Treatment (when microbiology results are known)|
If microbiology results become available discuss on a case by case basis.
|Duration of Treatment|
Duration of therapy should be determined by severity of infection and clinical response. 5 days of therapy may be sufficient for non-severe pneumonia, while up to 10 days may be required in severe cases. (N.B. longer duration of therapy may be required in empyema).
|Switch to oral agent(s)|
In those on IV therapy consider an oral switch once there is clear improvement and oral medication is likely to be tolerated.
If there is a suspicion of pleural fluid on a CXR, a chest ultrasound should be performed. If fluid is confirmed on CXR, referral to the surgical team should be made plus discuss with the respiratory team.
Community acquired pneumonia in children (CAP)
|Target patient group:||Children (>4 weeks old - <16 years age)|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
References and Evidence levels:
- Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax Oct 2011;66 Suppl 2:ii1-ii23.
- Clark JE, Hammal D, Hampton F, Spencer D, Parker L. Epidemiology of community-acquired pneumonia in children seen in hospital. Epidemiol Infect. Feb 2007;135(2):262-269.
- PVL Subgroup of the Steering Group on Healthcare Associated Infection. Guidance on the Diagnosis and management of PVL-associated Staphylococcus Aureus Infections (PVL-SA) in England. 2nd ed. London: Health Protection Agency; 2008.
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)
Improving Antimicrobial Prescribing Group
LHP version 1.0
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