ÎAntibacterial therapy is not necessary for children, either outpatients or inpatients, with a positive test for influenza virus in the absence of clinical, laboratory, or radiographic findings that suggest bacterial coinfection. (SR-H)
ÎTesting for respiratory viruses other than influenza virus can modify clinical decision-making in children with suspected pneumonia, since antibacterial therapy will not routinely be required for these children in the absence of clinical, laboratory or radiographic findings that suggest bacterial coinfection. (WR-L)
Testing for Atypical Bacteria
ÎChildren with signs and symptoms suspicious for M. pneumoniae should be tested to help guide antibiotic selection. (WR-M)
ÎDiagnostic testing for Chlamydophila pneumoniae is NOT recommended since reliable and readily available diagnostic tests do not currently exist. (SR-H)
Ancillary Diagnostic Testing Complete Blood Count
ÎRoutine measurement of the complete blood count is not necessary in all children with suspected CAP managed in the outpatient setting but, for those with more serious disease, may provide useful information for clinical management in the context of the clinical examination and other laboratory and imaging studies. (WR-L)
ÎA complete blood count should be obtained for patients with severe pneumonia, to be interpreted in the context of the clinical examination and other laboratory and imaging studies. (WR-L)
Acute-Phase Reactants
ÎAcute-phase reactants such as the erythrocyte sedimentation rate, C-reactive protein, or serum procalcitonin cannot be used as the sole determinant to distinguish between viral and bacterial causes of CAP. (SR-H)
ÎAcute phase reactants need not be routinely measured in fully- immunized children with CAP who are managed as outpatients, although for more serious disease, acute-phase reactants may provide useful information for clinical management. (SR-L)
ÎIn patients with more serious disease such as those requiring hospitalization or those with pneumonia-associated complications, acute-phase reactants may be used in conjunction with clinical findings to assess response to therapy. (WR-L)
Pulse Oximetry
ÎPulse oximetry should be performed on all children with pneumonia and suspected hypoxemia. The presence of hypoxia should guide decisions regarding site of care and further diagnostic testing. (SR-M)
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