Consensus document on community-acquired pneumonia in children. SENP-SEPAR-SEIP

• Published in: Archivos de bronconeumología (English ed.) 2020-11, Vol.56 (11), p.725-741
• Main Authors: Andrés-Martín, Anselmo, Montaner, Amparo Escribano, Mulet, Joan Figuerola, García, Maria Luz García, Murua, Javier Korta, Moreno-Pérez, David, Rodrigo-Gonzalo de Liria, Carlos, Galdó, Antonio Moreno
• Format: Article
• Language: English
• Subjects: Antibioterapia; Antibiotic therapy; Community-acquired pneumonia; Complicaciones; Complications; Diagnosis; Diagnóstico; Drenaje pleural; Etiology; Etiología; Fibrinolytic; Fibrinolíticos; Neumonía adquirida en la comunidad; Pleural drainage; VATS
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/j.arbr.2020.09.002

Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows: Etiology depends mainly on age and other factors and no single analytical marker offers absolute diagnostic reliability. In the event of clinical suspicion of pneumonia in a healthy child, chest X-ray is not necessary. Chest ultrasound is increasingly implemented as a follow-up method, and even as a diagnostic method. The empirical antibiotic treatment of choice In typical forms of the disease is oral amoxicillin at a dose of 80 mg/kg/day for 7 days, while in atypical presentations in children older than 5 years, macrolides should be selected. In severe typical forms, the combination of 3rd generation cephalosporins and cloxacillin (or clindamycin or vancomycin) administered intravenously is recommended. If pleural drainage is required, ultrasound-guided insertion of a small catheter is recommended. Intrapleural administration of fibrinolytics (urokinase) reduces hospital stay compared to simple pleural drainage. In parapneumonic pleural effusion (PPE), antibiotic treatment combined with pleural drainage and fibrinolytics is associated with a similar hospital stay and complication rate as antibiotic treatment plus video-assisted thoracoscopy (VATS). Systematic pneumococcal conjugate vaccination is recommended in children under 5 years of age, as it reduces the incidence of CAP and hospitalization for this disease. La neumonía adquirida en la comunidad (NAC) es una enfermedad prevalente en la edad pediátrica y que ofrece frecuentemente dudas tanto diagnósticas como terapéuticas. Se ha realizado un consenso entre SEPAR, SENP y SEIP, con las siguientes conclusiones: La etiología depende fundamentalmente de la edad y de otros factores, como estado inmunitario, presencia de enfermedad de base o estado vacunal y no existe un marcador analítico único con una absoluta fiabilidad diagnóstica. Ante la sospecha clínica de neumonía, no es imprescindible la realización de una radiografía de tórax en los niños sanos. La ecografía torácica se va imponiendo como método de seguimiento, e incluso de diagnóstico. El tratamiento antibiótico empírico de elección en las formas típicas es la amoxicilina oral a una dosis de 80 mg/kg/ día generalmente durante 7 días, mientras que en las atípicas en mayores de 5 años son los macrólidos.