Pediatric pneumonia represents an acute lung infection of great clinical significance, being a leading cause of morbidity and mortality in children under 5 years of age worldwide. Its etiology varies significantly by age: viral agents (especially RSV, influenza, and adenovirus) predominate in infants and young children, while in schoolchildren, Streptococcus pneumoniae is the main bacterial pathogen, followed by Haemophilus influenzae type b and Mycoplasma pneumoniae, the latter characteristic of children over 5 years of age with more insidious symptoms and persistent cough.

The diagnosis is based on the identification of clinical signs such as tachypnea (rapid breathing according to age-specific parameters), fever, productive cough, and physical examination findings such as crackles or wheezing, depending on the etiology. Additional studies include chest x-ray, which may show distinctive patterns (lobar consolidation in bacterial cases versus bilateral infiltrates in viral cases), oximetry to assess the need for oxygen therapy (considering hypoxemia with saturations <92%), and biomarkers such as C-reactive protein and leukocyte count, which, although nonspecific, can indicate a bacterial etiology when significantly elevated.

The therapeutic approach should be individualized according to the suspected etiology and clinical severity: typical bacterial pneumonias respond favorably to oral amoxicillin (80-90 mg/kg/day) in outpatients, while atypical Mycoplasma pneumonias require macrolides such as azithromycin. Cases that meet criteria for severity (hypoxemia, severe respiratory distress, dehydration, or therapeutic failure) require hospitalization for intravenous treatment with third-generation cephalosporins, possibly combined with macrolides. Prevention through pneumococcal conjugate vaccination and vaccination against Haemophilus influenzae type b, along with measures such as breastfeeding and avoiding exposure to tobacco smoke, are fundamental pillars for reducing the incidence and severity of this disease.

References:

https://pediatria2024.sld.cu/index.php/pediatria/2024/paper/viewPaper/329