Afebrile Pneumonia Syndrome Treatment & Management

  • Author: Dagnachew (Dagne) Assefa, MD, FAAP, FCCP; Chief Editor: Michael R Bye, MD  more...
 
Updated: Oct 13, 2015
 

Approach Considerations

Usually, the degree of afebrile pneumonia syndrome (APS) is mild, although clinical and radiographic findings may appear out of proportion (particularly in infants with Chlamydia trachomatis infection); most infants do not require extensive diagnostic evaluation or hospitalization.

Infants who present with more severe illness may need prompt institution of empiric treatment, foregoing the risk of delay and expense of an extensive diagnostic evaluation. These infants often have viral illness, which does not respond to antibiotic therapy, but differentiating bacterial from viral illness is often difficult. Consider empiric antibiotic therapy if the potential benefits of early intervention outweigh the risks of unnecessary treatment.

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Pharmacologic Treatment

Infants in whom the clinical picture suggests afebrile pneumonia syndrome (APS) may benefit from a 10- to 14-day course of erythromycin. Newer macrolides and azalides are also effective and may be tolerated better (particularly azithromycin).

Recent reports suggest an association between early receipt of erythromycin and the development of hypertrophic pyloric stenosis. Whether such an association will be substantiated or whether the effect will extend to clarithromycin or azithromycin is unclear. Thus, antimicrobial therapy for APS should be considered in the light of this potential adverse outcome.

Antiviral therapy is used in the treatment of cytomegalovirus (CMV), but only when unusually severe disease or immunocompromise is present. Severe CMV pneumonitis may require CMV hyperimmunoglobulin and antiviral therapy.

Although ribavirin is available for the treatment of RSV, disease sufficiently severe enough to merit treatment would not be APS and is beyond the scope of this discussion.

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Deterrence and Prevention

Detection and treatment of maternal C trachomatis infection prevents vertical transmission of the pathogen.[14] Avoidance of other risk factors for APS is prudent. Institute appropriate isolation of all patients who are hospitalized.

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Consultations

Consultation with specialists in pulmonary and infectious diseases may be helpful for more serious disease or in difficult cases.

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Contributor Information and Disclosures
Author

Dagnachew (Dagne) Assefa, MD, FAAP, FCCP Pediatric Pulmonologist, Pediatric Lung Care, Bon Secours

Dagnachew (Dagne) Assefa, MD, FAAP, FCCP is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, American College of Chest Physicians, American Thoracic Society, European Respiratory Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Susanna A McColley, MD Professor of Pediatrics, Northwestern University, The Feinberg School of Medicine; Director of Cystic Fibrosis Center, Head, Division of Pulmonary Medicine, Children's Memorial Medical Center of Chicago

Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, American Thoracic Society

Disclosure: Received honoraria from Genentech for speaking and teaching; Received honoraria from Genentech for consulting; Partner received consulting fee from Boston Scientific for consulting; Received honoraria from Gilead for speaking and teaching; Received consulting fee from Caremark for consulting; Received honoraria from Vertex Pharmaceuticals for speaking and teaching.

Acknowledgements

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Judith R Grisi, PA-C Physician Assistant, Monmouth Ocean Pulmonary Medicine, CentraState Medical Center

Disclosure: Nothing to disclose.

References
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