Pediatric Community-Acquired Pneumonia: Diagnosis and Management in the Urgent Care Setting (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: January 2024 (Volume 3, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 01/01/2027.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease and 1 Pharmacology CME credits, subject to your state and institutional requirements.

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Abstract

Distinguishing viral from bacterial causes of pneumonia in the urgent care setting is paramount to providing effective treatment but remains a significant challenge. For pediatric patients who can be managed with outpatient treatment, the utility of laboratory tests and radiographic studies, as well as the need for empiric antibiotics, remains questionable. This issue reviews viral and bacterial etiologies of community-acquired pneumonia in pediatric patients, offers guidance for obtaining historical information and interpreting physical examination findings, discusses the utility of various diagnostic techniques, and provides recommendations for the treatment of previously healthy and medically fragile children.

Case Presentations

A previously healthy 4-year-old girl is brought to urgent care for fever and abdominal pain that started 10 hours ago...

• The girl’s temperature is 39.4°C (103°F).
• On examination, she is ill-appearing states that her belly hurts. Although she complains of severe abdominal pain, the pain cannot be localized to a specific quadrant.
• There is no respiratory distress, and her lungs are clear to auscultation.
• You recall that pneumonia can present as abdominal pain and wonder if that could be the case for this patient. Should you transfer the patient to a higher level of care for further evaluation or continue the evaluation in the urgent care?

A previously healthy 8-year-old girl presents to urgent care with fever ranging from 38.9°C to 39.4°C (102°F to 103°F) and cough for 8 days...

• She was started on amoxicillin-clavulanate 2 days prior but has not improved. On examination, she is alert, nontoxic, and not in respiratory distress.
• Chest auscultation reveals decreased breath sounds and rales in the left lower lobe.
• The high fever and localized chest findings prompt you to order a chest x-ray, which shows a large left-sided pleural effusion.
• As you look at the film, you begin to wonder…what is the best next step in management for this patient?

A 2-year-old boy is brought to the urgent care clinic with complaints of fever and difficulty breathing...

• His past medical history includes a prior hospitalization for pneumonia. His immunizations are up to date.
• His temperature is 39.4°C (103°F). He appears nontoxic. He is in moderate respiratory distress with a pulse oximetry of 92% on ambient air, and his respiratory rate is 56 breaths/min.
• Chest auscultation reveals bilateral wheezes and localized rales in the left lower lobe.
• As you consider starting antibiotics and transferring the patient to a higher level of care, you wonder whether it is common for children to have repeat episodes of pneumonia. Are there are other questions on the review of systems that might be helpful in this patient?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.