-We strongly recommend based on low quality evidence consideration of further evaluation including repeat CXR, change in antibiotics or ID consultation in a patient without clinical improvement after 48-72 hours of therapy
Children with bacterial PNA on adequate antibiotic therapy should show signs of improvement within 48-72 hours (Bradley, Byington et al. 2011; Harris, Clark et al. 2011). For children that do not show this improvement, further investigation should be performed. Our recommendation is to re-evaluate with a CXR in addition to clinical exam, vital signs and laboratory findings, for the presence of a clinically significant pleural effusion that would alter antibiotic choice and possible surgical management of the patient. We would also recommend consideration of alternative diagnosis including viral lower respiratory tract infection, foreign body aspiration, aspiration pneumonia, tumor or mass, tuberculosis or histoplasmosis or other uncommon lung infection. Additionally, consideration of an Infectious Diseases consult is recommended for a patient with concern for an infectious process that is not clinically improving.