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  • Presenting signs and symptoms of pneumonia in infants and children may be nonspecific.

  • The primary predictor of the etiologic agent for infectious pneumonia is the patient’s age, and empiric antibiotic therapy, if indicated, should be based on the most likely etiologic organisms.

  • Antibiotics are not indicated for viral pneumonia. However, in previously healthy, immunized infants, children and adolescents with mild to moderate bacterial community acquired pneumonia, amoxicillin is first-line therapy.

Pneumonia, an inflammatory process affecting the lung parenchyma, is usually due to an infectious etiology (Table 37-1). Signs and symptoms such as rales, cough, and fever may lead to a clinical diagnosis of pneumonia. Pneumonia is usually diagnosed by an abnormal chest radiograph (CXR). The clinical spectrum of pneumonia varies from mild to life-threatening disease with significant morbidity and mortality. Given the large numbers of agents that cause pneumonia, and limitations of diagnostic testing, the exact cause is often unknown. However, a constellation of clinical, radiologic, and laboratory findings may suggest a likely pathogen, and therefore appropriate therapy (Table 37-2).

TABLE 37-1Causes of Pneumonia
TABLE 37-2Pneumonia Syndromes: Based on Etiologic Agenta

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