Community-Acquired Respiratory Infections in Pediatrics

Etiology and Diagnosis

The American Academy of Pediatrics recommends that the diagnosis of community-acquired pneumonia be based on clinical presentation, including cough or difficulty breathing, with or without fever, and that the use of chest radiographs be reserved for cases where the diagnosis is uncertain or there are signs of severe disease 1, 2.
Viruses are responsible for up to 80% of cases in children under 2 years, while bacteria predominate in older children 1, 2.
The most common viral pathogens are respiratory syncytial virus (RSV), adenovirus, bocavirus, metapneumovirus, influenza A and B, parainfluenza, coronavirus, and rhinovirus 2.
The most common bacterial pathogens are Streptococcus pneumoniae and Mycoplasma pneumoniae 1, 2.

The American Academy of Pediatrics recommends amoxicillin as the first-line antibiotic for community-acquired pneumonia in children, with a dose of 90 mg/kg/day divided into 2 doses 5.
For children with severe disease or those who have received antibiotics in the previous 4-6 weeks, amoxicillin-clavulanate may be considered as an alternative 6, 5.
The use of macrolides, such as azithromycin or clarithromycin, may be considered for children with suspected atypical bacterial pathogens, such as Mycoplasma or Chlamydia 6, 5.

The American Academy of Pediatrics recommends that the diagnosis of acute otitis media be based on the presence of middle ear effusion and signs of inflammation, such as bulging of the tympanic membrane or otalgia 6.
Amoxicillin is recommended as the first-line antibiotic for acute otitis media, with a dose of 90 mg/kg/day 6.
The use of amoxicillin-clavulanate may be considered for children who have received antibiotics in the previous 4-6 weeks or have moderate to severe disease 6.

The American Academy of Pediatrics recommends that the diagnosis of acute sinusitis be based on the presence of persistent or worsening symptoms, such as nasal discharge or cough, despite adequate treatment for an upper respiratory tract infection 9, 6.
Amoxicillin or amoxicillin-clavulanate is recommended as the first-line antibiotic for acute sinusitis, with a dose of 90 mg/kg/day 6.

The American Academy of Pediatrics recommends that high-risk infants, such as those with congenital heart disease or premature birth, receive prophylaxis with palivizumab to reduce the risk of severe RSV disease and hospitalization 4, 10.