Community-Acquired Pneumonia (CAP) Clinical Pathway

Pathway Background and Objectives

Community-Acquired Pneumonia (CAP) is among the most common causes for hospitalization and is responsible for 124,000 hospitalizations annually. In 2011, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America released a clinical practice guideline with evidence-based recommendations for the management of CAP in infants and children. Since then, there has been a significant amount of literature clarifying CAP etiology, management and appropriate duration of treatment, in tandem with increasing susceptibility rates of S. pneumoniae to amoxicillin/ampicillin. The CAP clinical pathway was updated in 2023 to emphasize the selection of the narrowest appropriate antibiotic depending on the presence or absence of CAP complications (rather than the severity of the patient’s overall clinical presentation), decrease the utilization of azithromycin (as it has no significant clinical benefit for mycoplasma-associated uncomplicated CAP), and recommend a shorter duration of antibiotics.

The objectives of this pathway are to:

  • Decrease variation in antibiotic usage for CAP
  • Decrease unnecessary use of broad spectrum antibiotics
  • Optimize ampicillin/amoxicillin dosing for local pneumococcal resistance
  • Decrease unnecessary use of azithromycin
  • Decrease antibiotic usage to shortest effective duration

     

Algorithm  Educational Module 

  • Percentage of patients with CAP with use of CAP pathway order set
  • Percentage of patients with CAP with appropriate antibiotic selection per pathway (inpatient and discharge)
  • Percentage of patients with CAP correct antibiotic dosage per pathway (inpatient and discharge)
  • Percentage of patients with CAP who receive amoxicillin/ampicillin in the Emergency Department
  • Average duration of antibiotic course (days)
  • Percentage of patients with CAP with negative nasal MRSA PCR and vancomycin or linezolid discontinued within 24 hours of negative result
  • Percentage of patients with uncomplicated CPA who have a blood culture performed
  • ALOS (days) 
     
  • American Association for Thoracic Surgery. (2017). The American Association for Thoracic Surgery consensus guidelines for the management of empyema. The American Association for Thoracic Surgery. 153:e129-46. DOI:10.1016/j.jtcvs.2017.01.030.
  • Biondi, E., McCulloh, R., Alverson, B., Klein, A., Dixon, A., Ralston, S. (2014). Treatment of Mycoplasma Pneumonia: A Systematic Review. Pediatrics. 133(5):1081-1090. DOI:10.1542/peds.2013-3729.
  • Bradley, J.S., Cyington, C., Shah, S.S., et al. (2011). The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases. 53(7):e25-e76. DOI: 10.1093/cid.cir531.
  • Griffiths, U.K., Clark, A., Gessner, B., Sanderson, C., Sedyaningsih, E.R., Mulholland, K.E. (2012). Dose-specific efficacy of Haemophilus influenza type b conjugate vaccines: a systematic review and meta-analysis of controlled clinical trials. Epidemiology and Infection. 140(8): 1343-1355. DOI: 10.1017/S0950268812000957.
  • Pernica, J.M., Harman, S., Kam, A.J., Carciumaru, R., Vanniyasingam, T., et al. (2021). Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: the SAFER Randomized Clinical Trial. JAMA Pediatrics. 175(5):475-482. DOI: 10.1001/jamapediatrics.2020.6735.
  • Same, R.G., Amoah, J., Hsu, A.J., Hersh, A.L. et al. (2021). The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children. Journal of Pediatric Infectious Diseases Society. 10(3):267-273. DOI: 10.1093/jpids/piaa055.
  • Williams, D.J., Edwards, K.M., Self, W.H., Zhu, Y., Arnold, S.R., McCullers, J.A., et al. (2017). Effectiveness of B-Lactam Monotherapy vs Macrolide Combination Therapy for Children Hospitalized with Pneumonia. JAMA Pediatrics. 171(12):1184-1191. DOI: 10.1001/jamapediatrics.2017.3225. 
     

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.