Guidelines Support Vaccines to Prevent Pneumonia in Children

The most effective way to protect children from life-threatening pneumonia is with immunizations, including an annual influence vaccine, according to new guidelines developed by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA).

The guidelines, which are published in the Oct. 1, 2011 issue of Clinical Infectious Diseases, are the first to focus on diagnosing and treating community-acquired pneumonia (CAP) in infants and children, placing preventing bacterial pneumonia as a top priority.

Although there are guidelines for diagnosing and treating pneumonia in adults, the course of bacterial pneumonia tends to differ in children. Because of this, practices vary from hospital to hospital, and physician to physician. The guidelines from PIDS and IDSA provide all health care providers who care for children with a roadmap to the most scientifically valid diagnosis and treatment recommendations.

“Diagnostic methods and treatments that work well in adults may be too risky and not have the desired result in children,” said John S. Bradley, MD, lead author of the CAP guidelines and professor and chief of the division of infectious diseases at the University of California at San Diego Department of Pediatrics. “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.”

Because viral infections such as influenza can develop into bacterial pneumonia, it’s important that children 6 months and older receive a yearly influenza vaccine, according to the guidelines. It is also important that infants and children are up to date on their other scheduled vaccines, several of which prevent bacterial pneumonia. The successful US vaccination program has significantly reduced bacterial pneumonia, and therefore has prevented deaths from the infection, notes Dr. Bradley.

While the guidelines stress the importance of diagnosing pneumonia appropriately, they also warn that over-treatment is a critical concern. For instance, most pneumonia in preschool-aged children is viral. In these cases, there is no need to perform unnecessary medical interventions such as using x-rays or prescribing antibiotics.

“A child with chest congestion, a cough, runny nose and low-grade fever likely has viral pneumonia, and Mother Nature treats those herself,” said Dr. Bradley in a statement. “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.”

Some of the recommendations included in the guidelines are as follows:

• Infants aged 3 to 6 months old with suspected bacterial pneumonia are likely to benefit from hospitalization, even if the pneumonia isn’t confirmed by blood tests.
• Because infants 6 months and younger cannot get the flu shot or nasal spray, their parents and caregivers should be sure to get the vaccine.
• When antibiotics are necessary, amoxicillin should be first-line therapy for bacterial pneumonia, because it is safe and effective. Many doctors prescribe more powerful antibiotics, which are unnecessary and can kill off good bacteria in the body.
• Although pneumonia from methicillin-resistant Staphylococcus aureus (MRSA) is uncommon, it can cause severe illness, so physicians need to consider it if a child doesn’t improve after first-line antibiotic therapy.

For each of the 92 specific recommendations, the guidelines denote the strength of the recommendation as well as the quality of evidence for each. The guidelines note the lack of solid evidence in some areas—often due to the ethical challenges of studying children—and call for research in specific areas.

“We’re hopeful that in following these guidelines, physicians and hospitals will collect data and the results can be compared,” said Dr. Bradley. “We envision this as the first of many revisions of guidelines to come.”