Treatment of community-acquired pneumonia in Korean children

You Hoon Jeon; Jeong Hee Kim

doi:10.4168/aard.2017.5.4.177

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

Review

Allergy Asthma Respir Dis 2017;5(4):177-184.

Published online: 5 July 2017

DOI: https://doi.org/10.4168/aard.2017.5.4.177

Treatment of community-acquired pneumonia in Korean children

You Hoon Jeon¹, Jeong Hee Kim²

¹Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea

²Department of Pediatrics, Inha University Hospital, Incheon, Korea

Correspondence to: Jeong Hee Kim https://orcid.org/0000-0002-7054-8552 Department of Pediatrics, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea Tel: +82-32-890-2843, Fax: +82-32-890-2844, E-mail: kimjhmd@inha.ac.kr

Received 1 March 201713 April 2017 Accepted 15 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pneumonia, Child, Korea

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Fig. 1.

Number of publications about pediatric pneumonia in Korea depending on calendar year.

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.

Fig. 3.

Number of pneumonia visits to medical institutions. Aadapted from National Health Insurance Corporation database.

Fig. 4.

Number of death from pneumonia in Korean children. Aadapted from National Health Insurance Corporation database.

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).

Table 1.

Empiric therapy for pediatric community-acquired pneumonia

Site of care	Empiric therapy
Site of care	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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