Practice Clinical updates

Community acquired pneumonia in children

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j686 (Published 02 March 2017) Cite this as: BMJ 2017;356:j686
  1. Iram J Haq, registrar and clinical research associate in paediatric respiratory medicine1 2,
  2. Alexandra C Battersby, registrar in paediatric immunology and infectious diseases3,
  3. Katherine Eastham, consultant paediatrician4,
  4. Michael McKean, consultant in paediatric respiratory medicine and clinical director2
  1. 1Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  2. 2Department of Paediatric Respiratory Medicine, Great North Children’s Hospital, Newcastle upon Tyne
  3. 3Department of Paediatric Immunology and Infectious Diseases, Great North Children’s Hospital, Newcastle upon Tyne
  4. 4Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK

Correspondence to: I J Haq iram.haq@newcastle.ac.uk

What you need to know

  • Introduction of the pneumococcal conjugate vaccine has significantly reduced rates of community acquired pneumonia (CAP) in the developed world

  • Clinical assessment requires careful evaluation of clinical features, severity, and evidence of complications

  • Children with mild to moderate symptoms can be managed in the community

  • Recommended empirical first line treatment is oral amoxicillin. Intravenous antibiotics are indicated in children who cannot tolerate oral medicines or have septicaemia or complications

  • Patients should be reviewed 48 hours after starting treatment to monitor response and for evidence of complications

In 2015, community acquired pneumonia (CAP) accounted for 15% of deaths in children under 5 years old globally and 922 000 deaths globally in children of all ages.1 It is defined as a clinical diagnosis of pneumonia caused by a community acquired infection in a previously healthy child.2 Clinical assessment can be challenging; symptoms vary with age and can be non-specific in young children, and aetiology is often unknown at presentation.

This article will provide an update on CAP management in otherwise healthy children outside the neonatal period and summarises recommendations from the British Thoracic Society guidelines for UK practice.2 Similar international guidelines, including the World Health Organisation and Infectious Diseases Society of America guidelines, have some treatment variations, probably dependent on drug availability, cost, and antibiotic resistance patterns.34

How common is CAP?

Around 14.4 per 10 000 children aged over 5 years and 33.8 per 10 000 under 5 years are diagnosed with CAP annually in European hospitals.56 CAP is more common in the developing world, estimated at 0.28 episodes per child per year and accounting for 95% of all cases.7 Incidence data varies and may be explained by variation in diagnostic criteria. A bias exists towards hospital based studies, which potentially underestimates overall incidence. Children aged …

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