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

Algorithm  Educational Module 

 

 

 

Exclamation point in speech red speech bubble

National IV Fluid Shortage

  • Due to the national IV fluid shortage, please consider utilizing oral hydration for patients that are able to tolerate. 
  • Please consider NG tube for administration of fluids/nutrition. This is generally well tolerated in infants.
  • If fluid boluses are necessary, consider using 10 mL/kg instead of 20 mL/kg boluses.

  • Percentage of patients with CAP with use of CAP pathway order set 
  • Percentage of patients with CAP with appropriate inpatient antibiotic selection per pathway 
  • Percentage of patients with CAP correct inpatient antibiotic dosage per pathway
  • Percentage of patients with CAP who receive amoxicillin/ampicillin in the Emergency Department 
  • Percentage of patients with CAP with appropriate discharge antibiotic selection per pathway 
  • 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 
  • ALOS (days) 
  • Jennifer Girotto, PharmD
  • Grace Hong, APRN
  • Ilana Waynik, MD

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.