Community-Acquired Pneumonia: Judicious Use of Antibiotics or Treatment Failure?

You admit a previously healthy, moderately ill–appearing 2-year-old boy with bilateral crackles and a density in the right middle lobe on chest radiograph. He has been coughing and febrile for 4 days. After 2 days of treatment with 90 mg/kg per day of amoxicillin, his primary care physician requests admission due to failure to improve and mild dehydration. You wonder if there are any tests that can help determine the need for continued antibiotic therapy.

Pediatric hospitalists frequently treat community-acquired pneumonia (CAP). CAP has an incidence of 33 per 100 000 children <5 years of age and 14.5 per 100 000 children <16 years of age in the developed world,¹ and about one-half of these patients are admitted for inpatient care.² Although the etiology of CAP varies by age, Streptococcus pneumoniae is the most common causative agent of bacterial CAP.

Recent guidelines released by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America suggest treating CAP with ampicillin or penicillin G for the fully immunized infant or school-aged child or using a third-generation parenteral cephalosporin (ceftriaxone or cefotaxime) for hospitalized infants and children …