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Executive Summary: The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America
John S. Bradley1,a, Carrie L. Byington2,a, Samir S. Shah3,a, Brian Alverson4, Edward R. Carter5, Christopher Harrison6, Sheldon L. Kaplan7, Sharon E. Mace8, George H. McCracken Jr9, Matthew R. Moore10, Shawn D. St Peter11, Jana A. Stockwell12, and Jack T. Swanson13
+ Author Affiliations
1Department of Pediatrics, University of California San Diego School of Medicine and Rady Children?s Hospital of San Diego, San Diego, California
2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
3Departments of Pediatrics, and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, and Division of Infectious Diseases, Children?s Hospital of Philadelphia, Philadelphia, Pennsylvania
4Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island
5Pulmonary Division, Seattle Children?s Hospital, Seattle Washington
6Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
7Department of Pediatrics, Baylor College of Medicine, Houston, Texas
8Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio
9Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
10Centers for Disease Control and Prevention, Atlanta, Georgia
11Department of Pediatrics, University of Missouri?Kansas City School of Medicine, Kansas City, Missouri
12Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
13Department of Pediatrics, McFarland Clinic, Ames, Iowa
Correspondence: John S. Bradley, MD, Rady Children?s Hospital San Diego/UCSD, 3020 Children?s Way, MC 5041, San Diego, CA 92123 (jbradley@rchsd.org).
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Abstract
Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
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EXECUTIVE SUMMARY
Guidelines for the management of community-acquired pneumonia (CAP) in adults have been demonstrated to decrease morbidity and mortality rates [1, 2]. These guidelines were created to assist the clinician in the care of a child with CAP. They do not represent the only approach to diagnosis and therapy; there is considerable variation among children in the clinical course of pediatric CAP, even with infection caused by the same pathogen. The goal of these guidelines is to decrease morbidity and mortality rates for CAP in children by presenting recommendations for clinical management that can be applied in individual cases if deemed appropriate by the treating clinician.
This document is designed to provide guidance in the care of otherwise healthy infants and children and addresses practical questions of diagnosis and management of CAP evaluated in outpatient (offices, urgent care clinics, emergency departments) or inpatient settings in the United States. Management of neonates and young infants through the first 3 months, immunocompromised children, children receiving home mechanical ventilation, and children with chronic conditions or underlying lung disease, such as cystic fibrosis, are beyond the scope of these guidelines and are not discussed.
Summarized below are the recommendations made in the new 2011 pediatric CAP guidelines. The panel followed a process used in the development of other Infectious Diseases Society of America (IDSA) guidelines, which included a systematic weighting of the quality of the evidence and the grade of the recommendation [3] (Table 1). A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of the guidelines.
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John S. Bradley1,a, Carrie L. Byington2,a, Samir S. Shah3,a, Brian Alverson4, Edward R. Carter5, Christopher Harrison6, Sheldon L. Kaplan7, Sharon E. Mace8, George H. McCracken Jr9, Matthew R. Moore10, Shawn D. St Peter11, Jana A. Stockwell12, and Jack T. Swanson13
+ Author Affiliations
1Department of Pediatrics, University of California San Diego School of Medicine and Rady Children?s Hospital of San Diego, San Diego, California
2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
3Departments of Pediatrics, and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, and Division of Infectious Diseases, Children?s Hospital of Philadelphia, Philadelphia, Pennsylvania
4Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island
5Pulmonary Division, Seattle Children?s Hospital, Seattle Washington
6Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
7Department of Pediatrics, Baylor College of Medicine, Houston, Texas
8Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio
9Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
10Centers for Disease Control and Prevention, Atlanta, Georgia
11Department of Pediatrics, University of Missouri?Kansas City School of Medicine, Kansas City, Missouri
12Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
13Department of Pediatrics, McFarland Clinic, Ames, Iowa
Correspondence: John S. Bradley, MD, Rady Children?s Hospital San Diego/UCSD, 3020 Children?s Way, MC 5041, San Diego, CA 92123 (jbradley@rchsd.org).
Next Section
Abstract
Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
Previous Section
Next Section
EXECUTIVE SUMMARY
Guidelines for the management of community-acquired pneumonia (CAP) in adults have been demonstrated to decrease morbidity and mortality rates [1, 2]. These guidelines were created to assist the clinician in the care of a child with CAP. They do not represent the only approach to diagnosis and therapy; there is considerable variation among children in the clinical course of pediatric CAP, even with infection caused by the same pathogen. The goal of these guidelines is to decrease morbidity and mortality rates for CAP in children by presenting recommendations for clinical management that can be applied in individual cases if deemed appropriate by the treating clinician.
This document is designed to provide guidance in the care of otherwise healthy infants and children and addresses practical questions of diagnosis and management of CAP evaluated in outpatient (offices, urgent care clinics, emergency departments) or inpatient settings in the United States. Management of neonates and young infants through the first 3 months, immunocompromised children, children receiving home mechanical ventilation, and children with chronic conditions or underlying lung disease, such as cystic fibrosis, are beyond the scope of these guidelines and are not discussed.
Summarized below are the recommendations made in the new 2011 pediatric CAP guidelines. The panel followed a process used in the development of other Infectious Diseases Society of America (IDSA) guidelines, which included a systematic weighting of the quality of the evidence and the grade of the recommendation [3] (Table 1). A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of the guidelines.
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