Clinical Practice Guidelines for Pediatric Community-Acquired Pneumonia

Diagnostic Approach

• Pulse oximetry must be performed in all children with suspected pneumonia to guide site-of-care decisions and determine need for hospitalization, as recommended by the Infectious Diseases Society of America 1, 2, 3
• Hypoxemia (SpO2 <90% at sea level) is a critical indicator for hospitalization and further diagnostic workup, according to the Infectious Diseases Society of America 4, 5

Laboratory Testing

• Blood cultures should not be obtained in nontoxic, fully immunized children managed as outpatients, as stated by the Infectious Diseases Society of America 4, 5
• Complete Blood Count (CBC) is not routinely necessary for outpatients, but should be obtained for severe pneumonia requiring hospitalization, as recommended by the Infectious Diseases Society of America 1, 2, 3

Hospitalization Criteria

• Children requiring hospitalization include those with moderate to severe CAP with respiratory distress and hypoxemia (SpO2 <90% at sea level), as stated by the Infectious Diseases Society of America 4, 5

Treatment Approach

• The American Academy of Pediatrics recommends first-line treatment for hospitalized children as ampicillin-sulbactam (or amoxicillin-clavulanate if oral intake tolerated) plus azithromycin to cover typical bacterial pathogens and atypical organisms 8
• The Infectious Diseases Society of America recommends maintaining SpO2 >92% at all times, with supplemental oxygen via nasal cannula, head box, or face mask if SpO2 <92% on room air 8, 7

Follow-up Imaging

• Repeated chest radiographs are not routinely required in children recovering uneventfully from CAP, as stated by the Infectious Diseases Society of America 1, 6

Discharge Criteria

• Discharge criteria include being afebrile for ≥24 hours, oxygen saturation >92% on room air, normalized respiratory rate, improved work of breathing, and tolerating oral intake, as recommended by the American Academy of Pediatrics 8