Community acquired pneumonia in children is an acute lower respiratory tract infection characterized by fever, chills, cough and unusually rapid breathing. The causes can range from viruses such as influenza A and B and adenovirus to bacteria like Streptococcus pneumoniae and Haemophilus influenzae. Several factors influence the treatment plan for pneumonia in children, including age and the micro-organism responsible. Hospitalization is required, especially for infants under 3 months of age and children who have hypoxemia and dehydration.
Anti-pyretics
Anti-pyretics, or fever reducers, like acetaminophen and ibuprofen are given to children to bring down their body temperature. However, the World Health Organization states that early use of anti-pyretics may mask the symptoms of pneumonia in children so they may not receive a proper diagnosis and treatment.
Antibiotics
Antibiotics are the first line of defense against childhood pneumonia caused by bacteria. According to the guidelines issued by the U.S. Department of Health and Human Services, children under 5 years of age should be treated with high doses of amoxycillin for seven to 10 days. Macrolides or cephalosporins can be used to treat children who are allergic to penicillin. Mycoplasma and chlamydia infections are rare in this age group but, if present, can be treated with macrolides.
In children over 5 years of age, macrolide antibiotics can be used for seven to 10 days to treat pneumonia caused by bacteria like Streptococcus pneumoniae. Severe cases can be treated using a combination of macrolides and cefotaxime. Vancomycin is used to treat pneumonia-caused methicillin resistant staphylococcus aureus, or MRSA. Hospitalized children with severe infections should be given oral amoxycillin along with intravenous penicillin. Gentamicin can be added in some cases. Rifampin and vancomycin can be given to children who are allergic to penicillin. If the pneumonia is caused by viruses, then antibiotics are ineffective. Antivirals like oseltamivir and zanamivir can be used to treat severe cases.
Intravenous Fluids
Dehydration is a common complication of pneumonia, especially in infants and young children. Patients should consume excessive amounts of fluids like water. In cases where the child is not able to take in fluids, hospitalization and intravenous administration of fluids is required. Fluids also help to break the phlegm in the lungs, thereby clearing the infections.
Oxygen Therapy
Hypoxemia, a decreased amount of oxygen in the blood, is a major contributor to the deaths in children with community acquired pneumonia. In fact, hypoxemia increases the risk of death by up to five times in children with pneumonia. Oxygen therapy is essential to counter this and involves administration of oxygen in concentrations higher than that in the room environment. A simple face mask or a nasal cannula can be used for the purpose.
References
- AAP Policy: Therapy for Children With Invasive Pneumococcal Infections
- Cochrane Library: Antibiotics for Community-acquired Pneumonia in Children
- National Guidelines Clearinghouse: Evidence-based Care Guideline for Community-acquired Pneumonia in Children 60 Days through 17 Years of Age
- World Health Organization: Oxygen Therapy for Acute Respiratory Infections in Young Children in Developing Countries
- "The New England Journal of Medicine"; Community-Acquired Pneumonia in Children; K. McIntosh; Feb. 2002
