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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.
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  (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.
Blood Cultures: Outpatient
Blood Cultures: Inpatient
Follow-up Blood Cultures
Sputum Gram Stain and Culture
Urinary Antigen Detection Tests
Complete Blood Cell Count
Initial Chest Radiographs: Outpatient
Initial Chest Radiographs: Inpatient
Follow-up Chest Radiograph
The members of the panel wish to express their gratitude to Drs Joseph St Geme, Richard L. Hodinka, Michael Light, and Karen L. McGowan for their thoughtful review of earlier drafts of the manuscript. In addition, the panel is greatly indebted to Jennifer Padberg, MPH (IDSA), and Christy Phillips, MSA (PIDS), for exceptional organizational skills in coordinating meetings, conference calls and several drafts of the guidelines manuscript conforming to the new GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) method of assigning a strength to the recommendations and the quality of the evidence.
The recommendations in this report do not represent an official document of the Centers for Disease Control and Prevention.
Financial support.This work was supported by the IDSA.
Potential conflicts of interest.J. S. B. has received no pharmaceutical funding or support during the past 36 months for management of pediatric CAP. C. L. B. served as principal investigator on Wyeth/Pfizer clinical trials of PCV13; the funding was to her employer, the University of Utah. C. H. has received honoraria from Sanofi Pasteur, and his employer has received grant funds for research performed by C. H. from Johnson & Johnson Pharmaceuticals, Cubist, Merck, Sanofi Pasteur, Astellas, and GlaxoSmithKline. S. L. K. has served as a consultant for Pfizer, GlaxoSmithKline, and Novartis. S. E. M. has served as principal investigator on a Gebauer clinical trial for vapocoolant and a clinical site investigator for a multicenter Baxter Hylenex clinical trial, the funding for both trials was to her employer, the Cleveland Clinic; she has also served as consultant for Baxter Health Care, Halozyme Therapeutics, Pricara (Ortho-McNeil-Janssen), Rox-888, and Venasite. J. A. S. has given expert testimony for Finley, Alt, Smith, and Schamberg. S. S. S. receives research support from the National Institutes of Health and the Robert Wood Johnson Foundation. He received past research support from Wyeth Pharmaceuticals (completed September 2009); the funding was to his employer. All other authors:No reported conflicts.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.