Journal List > Allergy Asthma Respir Dis > v.5(4) > 1059255

Jeon and Kim: Treatment of community-acquired pneumonia in Korean children

Abstract

Community-acquired pneumonia is the leading cause of pediatric morbidity and mortality. However, there is a lack of data on the epidemiology of pneumonia in Korean children. In this review, we aimed to summarize pneumonia studies in Korea and suggest diagnostic methods and treatment for Korean children who were referred based on the foreign guidelines for pediatric community-acquired pneumonia. A Korean guideline for pediatric pneumonia in tune with domestic circumstances is needed.

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Fig. 1.
Number of publications about pediatric pneumonia in Korea depending on calendar year.
aard-5-177f1.tif
Fig. 2.
(A) Number of publications on pneumonia in Korean children according to Korea Citation Index (KCI) or Science Citation Index (Expanded) (SCI(E)), (B) Number of papers about pneumonia in Korean children published by Allergy, Asthma and Respirator Diseases or Pediatric Infection and Vaccine during past 20 years.
aard-5-177f2.tif
Fig. 3.
Number of pneumonia visits to medical institutions. Aadapted from National Health Insurance Corporation database.
aard-5-177f3.tif
Fig. 4.
Number of death from pneumonia in Korean children. Aadapted from National Health Insurance Corporation database.
aard-5-177f4.tif
Fig. 5.
Changes of pneumonia mortality in Korean children before and after in-troduction of pneumococcal vaccine (from 1.2 to 0.5 per 100,000 in 1–4 years old age group; P=0.0175).
aard-5-177f5.tif
Table 1.
Empiric therapy for pediatric community-acquired pneumonia
Site of care Empiric therapy
Presumed bacterial pneumonia Presumed atypical pneumonia Presumed influenza pneumonia
Outpatient      
 <5 Years old (preschool) Amoxicillin, oral (90 mg/kg/day in 2 doses) alternative: oral amoxicillin clavulanate (amoxicillin component, 90 mg/kg/day in 2 doses) Azithromycin oral (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5); alternatives: oral clarithromycin (15 mg/kg/day in 2 doses for 7–14 days) or oral erythromycin (40 mg/kg/day in 4 doses) Oseltamivir
 ≥5 Years old Oral amoxicillin (90 mg/kg/day in 2 doses); (macrolide can be added to a β-lactam antibiotic for empiric therapy for atypical pneumonia) alternative: oral amoxicillin clavulanate (amoxicillin component, Oral azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5); alternatives: oral clarithromycin (15 mg/kg/day in 2 doses to a maximum of 1 g/day); erythromycin, doxycycline or Oseltamivir or zanamivir (for children 7 years and older); alternatives: peramivir, oseltamivir and zanamivir (all intravenous) are under clinical investigation in children; intravenous zanamivir available for compassionate use
  90 mg/kg/day in 2 doses) minocycline for children >7 years old  
Inpatient (all ages)      
 Fully immunized with conjugate vaccines for Haemophilus influenzae type b and Streptococcus pneumoniae; local penicillin resistance in invasive strains of pneumococcus is minimal Ampicillin, amoxicillin/clavulanic acid, or penicillin G; alternatives: ceftriaxone or cefotaxime; addition of vancomycin or clindamycin for suspected CA-MRSA Azithromycin (in addition to β-lactam, if diagnosis of atypical pneumonia is in doubt); alternatives: clarithromycin or erythromycin; doxycycline , minocycline for children >7 years old; levofloxacin for children who have reached growth maturity, or who cannot tolerate macrolides Oseltamivir or zanamivir (for children ≥7 years old; alternatives: peramivir, oseltamivir and zanamivir (all intravenous) are under clinical investigation in children; intravenous zanamivir available for compassionate use
 Not fully immunized for H, influenzae type b and S. pneumoniae; local penicillin resistance in invasive strains of pneumococcus is significant Ceftriaxone or cefotaxime; addition of vancomycin or clindamycin for suspected CA-MRSA; alternative: levofloxacin; addition of vancomycin or clindamycin for suspected CA-MRSA As above As above

Modified from Bradley et al. Clin Infect Dis 2011;53:e25-e76, with permission of the Oxford University Press.4 CA-MRSA, community-associated methicillin-resistant Staphylococcus aureus.

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