Title:Management of Complicated Pneumonia in Childhood: A Review of Recent Literature
Volume: 12
Issue: 4
Author(s): John B. Darby*, Amrita Singh and Ricardo Quinonez
Affiliation:
- Department of Pediatrics, Baylor College of Medicine / Texas Children's Hospital. 1102 Bates Street, #FC1860 Houston, Texas, TX,United States
Keywords:
Childhood illness, community acquired pneumonia, complicated pneumonia, corticosteroids, fibrinolytics, S. pneumoniae.
Abstract: Background: Despite declining rates of community acquired pneumonia (CAP) in children,
complicated pneumonia has been on the rise in the last two decades. The management of complicated
pneumonia is challenging and continues to be an area of investigation. Despite recently published
guidelines, many gaps exist and recent studies attempt to answer challenging questions.
Objective: The aim was to review recently published literature to inform the clinician about the most
up to date management of complicated pneumonia in children.
Methods: Using Medline, a search of the medical literature was conducted in order to find relevant
clinical trials and review articles published in the last 5 years.
Results: Narrow spectrum antibiotics including ampicillin and azithromycin remain important first
line agents, but directed therapy towards causative pathogens is the ideal standard practice. Novel
DNA isolation technologies hold promise for raising the diagnostic yield of pleural fluid. Surgical interventions
are often required and new literature further supports the use of fibrinolytics and minimally
invasive chest tube thoracostomy. Not to be overlooked is the importance of supportive measures
including oxygen therapy and adequate fluid, electrolyte and nutrition support. The use of other
adjunctive therapies such as steroids in pediatric complicated pneumonia remains controversial.
Conclusion: Recent studies have shown promise in establishing best practices for evaluation and
management of complicated pneumonia in children. Despite these robust efforts however, many areas
are in need of future inquiry and prospective studies could help to better understand the optimal therapeutic
and diagnostic options for children with this common and persistent childhood illness.