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, forgoing 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.
Consultation with specialists in pulmonary and infectious diseases may be helpful for more serious disease or in difficult cases.
Go to Pneumonia, Pediatric for more complete information on this topic.
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).
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.
Macrolides are the first line of treatment for atypical pneumonia in children because of their low minimum inhibitory concentration and good safety profile; however, the increasing incidence of macrolide resistance is becoming a global concern. [17]
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.
Deterrence and Prevention
Detection and treatment of maternal C trachomatis infection prevents vertical transmission of the pathogen. [18] An estimated 10-20% of infants whose mothers have active, untreated C trachomatis infection will develop pneumonia. Studies have shown significantly reduced rates of chlamydial infection among infants born to women who received erythromycin compared with mothers who received no treatment. [2]
Avoidance of other risk factors for APS is prudent. Institute appropriate isolation of all patients who are hospitalized.
