Find more evidence-based

content at EBMedicine.net
Clinical Pathway for Management of Pediatric Patients With
Community-Acquired Pneumonia1

Patient presents with suspected CAP

Is the patient a candidate for hospitalizationa?

NO YES

NO Suspected viral etiology? • Obtain CXR, CBC with differential, and blood culture
• Consider inflammatory markers and testing for respiratory
viruses and mycoplasma (Class III)
YES

Concern for complications • No additional testing

or other etiologies? or antibiotic treatment For patients with suspected bacterial CAP:
is routinely required • If the patient is fully immunized and in an area with minimal
NO YES (Class II) penicillin resistance, administer ampicillin IV (Class II)
• Discharge patient home • If the patient is not fully immunized or is in an area with
with return precautions significant penicillin resistance, administer ceftriaxone IV (Class
II)
• Consider addition of vancomycin or clindamycin if the patient is
severely ill (Class II)
No additional testing is • Obtain CXR (Class II) • Consider addition of a macrolide if atypical pneumonia
routinely required • Consider ordering suspected (Class II)
(Class II) CBC with differential,
inflammatory markers,
and testing for
respiratory viruses and Are criteria for intensive care unit admissionb present?
mycoplasma (Class III)

NO YES

For patients with suspected bacterial CAP:

• Administer amoxicillin PO (Class I) Admit to regular floor Admit to PICU
• If the patient has a penicillin allergy, consider cefpodoxime,
cefdinir, or clindamycin a b
Criteria for hospitalization: Criteria for intensive care unit
• Consider addition of a macrolide if atypical pneumonia is
• Age < 6 months with admission:
suspected (Class II)
suspected bacterial CAP • Need for invasive or
(Class II) noninvasive ventilation
• Hypoxia < 92% on ambient air • Impending respiratory failure
Disposition and follow-up instructions: (Class I) • Hemodynamic instability
• Treat for a total of 7-10 days • Moderate-to-severe distress • Altered mental status
• See primary care provider within 2-3 days • Inability to tolerate oral • Hypoxia < 92% with FiO2 ≥
medications or maintain 0.50
hydration
Abbreviations: CAP, community-acquired pneumonia; CBC, complete • Moderate-to-large
blood cell count; CXR, chest x-ray; FiO2, fraction of inspired oxygen; parapneumonic effusion
IV, intravenous; PICU, pediatric intensive care unit; PO, by mouth. • Suspected empyema
• Social or compliance concerns
For Class of Evidence definitions, see page 13.

www.ebmedicine.net

Copyright © 2019 EB Medicine. All rights reserved. 12 Reprints: www.ebmedicine.net/pempissues