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Dr Narayanappa, Mysuru 15 January 2018

Etiologic agent - Virus; Pneumococcus; Mycoplasma; Staphylococcus.
Etiology of CAP in children: 0-3 months – Gram-negative bacilli; Chlamydia trachomatis; H. influenzae; Pneumococcus; Viral; 3 months-5 years – Viruses (RSV, Influenza, Parainfluenza, Adenovirus); H. influenzae; Pneumococcus; S. aureus; 5 years and above – Pneumococcus; Mycoplasma; Chlamydia; Viruses.
Specific investigations for CAP: Sputum gram stain and culture, sputum AFB smear, blood culture, urine pneumococcal antigen, antimycoplasma IgM, PCR/DFA for respiratory viruses.
Indications for IV antibiotics: Infants <3 months; respiratory distress, movement of alae nasi, subcostal and intercostal retraction; oxygen saturation <92% in room air; patient too sick to swallow.
Choice of empirical therapy: Outpatient

Age	First-line	Second-line	Suspected staph
3 months-5 years	Amoxycillin/Cotrimoxazole	Co-amoxiclav/Cefuroxime/Cefpodoxime	Ampicillin-Cloxacillin/Cefuroxime/Co-amoxiclav
5 years +	Amoxycillin	Macrolide/Co-amoxiclav/Cefpodoxime	Ampicillin-Cloxacillin/Cefuroxime/Co-amoxiclav

Age	First-line	Second-line	Suspected staph
0-3 months	Cefotaxime/Ceftriaxone + Aminoglycoside	Co-amoxyclav + Aminoglycoside	Cefotaxime/Ceftriaxone ± Vancomycin/Linezolid
3 months-5 years	Ampicillin/Co-amoxyclav/Cefuroxime	Co-amoxiclav/ Cefotaxime/Ceftriaxone	Cefotaxime/Ceftriaxone + Cloxacillin ± Vancomycin/Linezolid
5 years +	Ampicillin/Co-amoxiclav + Macrolides	Co-amoxiclav/Cefotaxime/Ceftriaxone + Macrolides	Cefotaxime/Ceftriaxone + Cloxacillin ± Vancomycin/Linezolid

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