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Flu prevention emphasized in first guidelines on CAP for children


Treatment guidelines on community-acquired pneumonia (CAP) are very clear on the critical first step: Make sure that your patients are immunized against influenza, a leading cause of pneumonia in children. The guidelines from 2 major infectious disease societies offer other valuable advice to help you diagnose accurately and respond effectively without over treating.

If you need yet another reason to recommend the flu vaccine this fall, it’s one of the best ways to prevent community-acquired pneumonia (CAP), according to new guidelines.

To prevent CAP, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America recommend annual immunization with influenza vaccine for all children and adolescents aged 6 months or older, parents and caretakers of infants younger than 6 months, and pregnant adolescents. Immunizations for Streptococcus pneumoniae, Haemophilus influenzae type b, and pertussis also are strongly advised.

The guidelines focus on preventing life-threatening bacterial pneumonia, particularly pneumococcal pneumonia and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia, which have been associated with preceding seasonal influenza virus infection. Pneumonia killed 525 children aged 15 years or younger in 2006, according to the Centers for Disease Control and Prevention (CDC). Viruses cause the majority of pneumonia in infants and young children, but bacterial pneumonia becomes increasingly likely as children age.

“With these guidelines, we are hopeful that the standard and quality of care children receive for community-acquired pneumonia will be consistent from doctor to doctor-providing much better treatment outcomes,” lead researcher John Bradley, MD, said about the guidelines, the first to address CAP in children.

The guidelines stress the importance of balancing the risks of overtreating with the need to diagnose accurately and respond effectively. “A child with chest congestion, a cough, runny nose and low-grade fever likely has viral pneumonia” and so does not require antibiotics and should not be subjected to x-rays, according to Bradley. “If the child has a fever of 104, is barely able to keep fluids down, just wants to lie in bed and is breathing fast, it may be bacterial pneumonia and require antibiotics and hospitalization.”

The societies recommend hospital admission for any pediatric patient with saturation of peripheral oxygen below 90% at sea level, in respiratory distress, or suspected of having CA-MRSA. In addition, infants younger than 3 to 6 months suspected of bacterial CAP and any child who may not be carefully monitored at home or available for follow-up are likely to benefit from hospitalization.

The guidelines note that many tests used to detect pneumonia in adults are less accurate in children and do not recommend them, in most cases, for children who can be treated on an outpatient basis. Amoxicillin is recommended as the first-line treatment for suspected mild to moderate bacterial CAP.

Children with CAP should be tested for influenza, and those who test positive should not be treated with antibiotics in the absence of other findings that suggest a bacterial infection. Even in the absence of confirmation of positive influenza test results, pediatricians are advised to administer influenza antiviral therapy as soon as possible in children who develop moderate to severe CAP if they suspect flu involvement.

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