From the Guidelines
Lobar pneumonia in pediatric patients should be managed with empiric antibiotic therapy, with amoxicillin as the first-line treatment at 90 mg/kg/day divided into two doses for 5-7 days, and hospitalization is necessary for infants younger than 3-6 months, children with respiratory distress, oxygen saturation below 92%, dehydration, or those unable to take oral medications, as recommended by the most recent guidelines 1.
Key Considerations
- The diagnosis of lobar pneumonia is typically made clinically, with imaging playing a role in identifying complications such as pleural effusion, pulmonary abscess, and bronchopleural fistula 1.
- The American College of Radiology Appropriateness Criteria recommend radiographs for screening for complications and ultrasound and CT for confirmation 1.
- The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America guidelines define "simple pneumonia" as either broncho-pneumonia or lobar pneumonia involving a single lobe, and "complicated pneumonia" as a pulmonary parenchymal infection complicated by parapneumonic effusions, multilobar disease, abscesses or cavities, necrotizing pneumonia, empyema, pneumothorax or bronchopleural fistula 1.
- Hospitalization is indicated in a previously healthy child with CAP and an oxygen saturation in room air (at sea level) of <90%, although some would hospitalize children who have oxygen saturations as high as 93% 1.
Management
- Empiric antibiotic therapy should be based on the child's age and likely pathogens, with amoxicillin as the first-line treatment at 90 mg/kg/day divided into two doses for 5-7 days 1.
- For children with penicillin allergy, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg daily for 4 more days) or clindamycin (30-40 mg/kg/day divided into three doses) 1.
- Supportive care includes adequate hydration, fever control with acetaminophen (15 mg/kg/dose every 4-6 hours) or ibuprofen (10 mg/kg/dose every 6-8 hours), and supplemental oxygen if needed 1.
Follow-up
- Follow-up imaging is generally unnecessary unless symptoms persist or complications are suspected 1.
- Clinical improvement is typically seen within 48-72 hours of starting antibiotics, and the consolidation pattern on chest X-ray usually resolves within 7-10 days 1.
From the Research
Lobar Pneumonia Findings on X-ray
- Lobar pneumonia is characterized by an acute inflammatory process that affects one or more lobes of the lung, and its findings on X-ray typically include consolidation of the affected lobe, which may be homogeneous or have a more patchy appearance 2.
- The diagnosis of lobar pneumonia is often made based on a combination of clinical presentation, laboratory tests, and radiographic findings, including X-ray and sometimes computed tomography (CT) scans 3.
Management in Pediatrics
- The management of lobar pneumonia in pediatric patients involves the use of antibiotics, with the choice of antibiotic depending on the suspected or confirmed causative pathogen and its susceptibility pattern 4, 5.
- For children with mild lobar pneumonia, step-down antibiotic therapy may be effective, with a reduction in the level of inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) 4.
- In cases of severe lobar pneumonia, step-down therapy has been shown to produce better results in relieving the inflammatory reaction, with a shorter course of antibiotic treatment and disappearance time of pulmonary rales 4.
- Empiric antibiotic choice for pediatric community-acquired pneumonia, including lobar pneumonia, is variable and highlights the need for heightened antimicrobial stewardship 3.
- Amoxicillin/clavulanate and azithromycin are among the antibiotics used to treat lobar pneumonia in children, with amoxicillin/clavulanate being more effective in eradicating or suppressing Streptococcus pneumoniae and Haemophilus influenzae 6.