Community-Acquired Pneumonia

Community-acquired pneumonia is an infection of the small airways and pulmonary parenchyma that develops in the outpatient setting. Despite the development of new antibiotics and vaccines, pneumonia is still a disease that occurs frequently in children under 5 years of age and is one of the main causes of mortality, especially in developing countries. The biggest challenge in treating pneumonia is to determine the agent, which depends on age, disease severity, immunological condition, geographic location, epidemiological situation, and immunizations. The classic clinical picture presents with fever, coughing, and difficulty in breathing. The physical examination shows tachypnea, reduced breath sounds, and fine crackles. Wheezing may be present in infants with viral pneumonia. The chest X-ray is considered an important tool to confirm the disease diagnosis and may guide specific treatment. Acute-phase reactants have a low sensitivity and specificity to distinguish between virus and bacteria. Microbiological identification does not have a clinical impact for most children with community-acquired pneumonia. Bronchoalveolar lavage may be considered for immunocompromised patients. Antibiotic treatment is empirical based on the best possible etiology, depending on the patient’s age and epidemiological timing. Amoxicillin is the treatment of choice for Streptococcus pneumoniae, and azithromycin is preferred for Mycoplasma pneumoniae.