Community acquired pneumonia
A third generation cephalosporin should be used for unvaccinated children admitted for community acquired pneumonia.
Most pediatric pneumonia is viral. The more common “Typical” bacterial pathogens seen in epidemiology studies are Streptococcus pneumoniae, Group A Streptococcus and Staphylococcus aureus.
Mycoplasma pneumonia is identified commonly and more so as children get older. Rare bacterial causes are viridans streptococci, C. pneumoniae, H. influenzae, Gram-negative bacteria, and other Streptococcus spp.
Ampicillin or penicillin G are used for IV therapy directed primarily at S pneumoniae however the 2015 IDSA guidelines recommend the use of a third-generation parenteral cephalosporin in some cases:
- Not fully immunized
- Local pneumococcal strains with resistance to penicillin
- Life threatening infections including empyema.
MRSA coverage with Vancomycin or clindamycin are added when clinical appearance, labwork or imaging are consistent with S. aureus infection.
References:
Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. 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. Clin Infect Dis. 2011 Oct;53(7):e25-76. PMID: 21880587
Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, Stockmann C, Anderson EJ, Grijalva CG, Self WH, Zhu Y, Patel A, Hymas W, Chappell JD, Kaufman RA, Kan JH, Dansie D, Lenny N, Hillyard DR, Haynes LM, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, Wunderink RG, Edwards KM, Pavia AT, McCullers JA, Finelli L; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015 Feb 26;372(9):835-45. PMID: 25714161