Community-Acquired Pneumonia - Factors Influencing Choice of Antibacterial Therapy in Child

age in years

young infants often have viral infections, especially if immunized

immunization status

more aggressive management required if not fully immunized

outpatient vs inpatient vs life-threatening

an outpatient can often be managed with oral therapy, while an inpatient often requires parenteral therapy

MRSA possible

addition of vancomycin or clindamycin

in a region with penicillin resistant Streptococcus pneumoniae

therapy with third generation cephalosporin (below)

other Streptococcus pneumoniae

may be resistant to macrolides

influenza

therapy with agents active against influenza can be beneficial, secondary bacterial infection may require antibiotic therapy, negative rapid test does not exclude the diagnosis

other virus

antibiotics not indicated unless secondary bacterial infection occurs

atypical bacteria

macrolide antibiotic

allergy to first-line therapy

select alternative agent or desensitize

failure of initial therapy

need to know pathogen and antibiotic susceptibility; confirm compliance, antibiotic dosing and kinetics

recurrent CAP

consider evaluation for immunodeficiency or a foreign body