Diagnosis, Treatment & Prevention of Community Acquired Pneumonia in Pediatrics

Community-acquired pneumonia (CAP) is a common pediatric infection [2]. It is defined as an acute infection of pulmonary parenchyma in a child caused by a pathogen acquired outside the hospital, that is, in the community [3]. The World Health Organization (WHO) estimates that approximately 2 million children under the age of 5 years die of pneumonia each year worldwide; the majority of these deaths occur in developing countries [4,5]. The mortality rate in developed countries is less than 1 per 1000 per year [6,7]. Africa experienced the highest disease burden with an estimated 0.27 pneumonia episodes per child-year [8]. In Egypt, it was estimated that 10% of childhood deaths below the age of 5 years is likely caused by pneumonia and other acute respiratory infections [9].

Nevertheless, community-acquired pneumonia is associated with enormous costs either directly through medical expenses or indirectly through loss of working hours by parents of sick children [10].

Although the specific etiologic agent is not identified in many cases of CAP in children, respiratory viruses such as RSV and Parainfluenza are detected in more than half of the cases [11]. Recently in 2019, COVID- 19 was discovered causing pandemic worldwide [12].

Pyogenic bacteria are detected in a relatively small proportion of CAP in children, but their early identification is critical, as they can cause severe.

and/or complicated pneumonia and even mortality [7]. Streptococcus pneumoniae is the most common bacterial cause of CAP. Mycoplasma pneumonia, Chlamydia pneumonia and Strep. pneumoniae are the predominant etiologies of CAP in school-aged children. Haemophilus influenza and group A Streptococci are fewer common causes [13].

The diagnosis is usually based on the clinical findings of fever, cough, respiratory distress (e.g. tachypnea, nasal flaring, intercostal, subcostal, and suprasternal retractions, and grunting), and/or radiologic evidence of an acute pulmonary infiltrate/consolidation [14, 15].

However, a reliable single test for identifying the specific pathogen (or pathogens) causing pneumonia does not exist, although an accurate and rapid etiologic diagnosis will result in improved care with focused antimicrobial therapy, fewer unnecessary tests and procedures and potentially shorter hospital stays in children with CAP [16].

The British Thoracic Society guidelines recommend that children with a clear clinical diagnosis of pneumonia should be treated with antibiotics, given that bacterial and viral pneumonia cannot be reliably distinguished from each other on clinical grounds [3].

Since the bulk of the global pneumonia disease burden occurs in countries with limited resources and weak health-care systems, a primary- care focused clinical case management approach was developed [17, 20]. The WHO acute respiratory infection case management strategy aimed to reduce child mortality by providing antibiotics to pneumonia cases and reducing inappropriate antibiotic use in children with upper respiratory tract infections [18].

➡️Purpose:

The intention of this CPG is to enhance appropriate utilization of community resources, decrease hospitalization and avoiding PICU admission, optimize medical management of patients with community acquired pneumonia (CAP), and provide optimal pharmacotherapy to prevent or minimize adverse effects of therapy.

This section describes what is intended with the guideline or what it is intended to achieve. For example, assisting or guiding Member States on determining a course of action, based on evidence, and leading to improvements in health indicators (e.g., mortality and disease prevalence), quality of life, or cost savings.

➡️Scope and target audience:

This CPG is intended to assist the practitioners, namely, pediatricians, primary health care (PHC) physicians, family practitioners, nurses, and clinical pharmacists to apply the best available evidence based researches to clinical decisions about the management of CAP in previously apparently healthy children older than 28 days up to 12 years.

This CPG is not intended to serve as a standard of medical care. Standards of care should be based on all the clinical data available for an individual case and are subjected to changes as scientific knowledge and technology advance in patterns of care evolve. The CPG recommendations will neither ensure a successful outcome in every case nor include all the proper methods of care. Also, they do not exclude other acceptable methods of care aimed at the same results.

The ultimate judgment must be made by the appropriate physician who is responsible for clinical decisions regarding a particular clinical procedure or treatment plan. This judgment should only be made following discussion of the options with the patient, in light of the diagnostic and treatment choices available. However, it is advised that significant departures from the national CPGs or any local CPGs derived from it should be fully documented in the patient’s case notes at the time the relevant decision is taken.

• The target audience or intended end-users of this CPG include physicians (pediatrics, pediatric pulmonology, infectious diseases, primary health care, family medicine), nurses, and clinical pharmacists who care for children with CAP in Egypt.