Diagnosis and Treatment of Community-Acquired Pneumonia in Children

I.A. Karymdzhanov, H.Kh. Iskanova, N.A. Israilova


In practice, especially in the outpatient setting, serious problems of pediatrics are early diagnosis and rational therapy of pneumonia in children. The most common pathogens in community-acquired pneumonia are Streptococcus pneumoniae, Haemophilus influenzae and other microorga­nisms, including viruses and fungi. It should be clarified that the etiology of diseases of the lower respiratory tract is very different in various age groups. The most common cause of the community-acquired pneumonia (up to 50 %) is S.pneumoniae, such bacilli as E.сoli, Klebsiella spp., C.trachomatis, Mycoplasma, Ureaplasma are more rare. In children older than 5 years, in the etiological structure of the community-acquired pneumonia, along with S.pneumoniae, the importance of Mycoplasma pneumoniae are increasing. The resistance of pathogens to antibacterial therapy — the growing global problem.
Algorithm for the diagnosis of community-acquired pneumonia includes febrile temperature lasting > 3 days, cyanosis, dyspnea in the absence of signs of bronchial obstruction, cough. Tachypnae is one of the best pneumonia predictors in children of all ages. Physical examination reveals the presence of dullness on percussion in the affected area, the bronchial or dimi­nished breath sounds, crackles or wheezing. For the diagnosis of moderate community-acquired pneumonia, it is enough to use clinical symptoms, X-ray of the lungs, common blood test.
The initial antibiotic therapy of community-acquired pneumonia is carried out empirically. In the treatment of severe community-acquired pneumonia in children from 2 months to 5 years, the drug of choice is amoxicillin orally. Macrolides are the drugs of choice for children aged 5 to 16 years. In severe pneumonia, drugs of choice are amoxicillin clavulanate, 2nd–4th generation cephalosporins. In general, the duration of antibiotic therapy in the community-acquired pneumonia caused by typical bacteria is 7–10 days, by atypical bacteria — 10–14 days. In the real clinical practice, the errors associated with the choice of drug, route of administration, dosage, regimen of application, length of treatment are frequent during antibacterial therapy.


community-acquired pneumonia; diagnosis; antibacterial therapy


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DOI: https://doi.org/10.22141/2224-0551.1.69.2016.73731


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