Empiric Management of Pneumonia Resulting in Change (EMPiRIC/Pneumocrit)

Community-acquired pneumonia (CAP) is one of the most common pediatric infections managed in the emergency department (ED), accounting for over 530,000 ED visits and 107,000 hospitalizations each year in the US. It is estimated that fewer than 25% of CAP are bacterial in etiology; however, 79% of children with CAP are prescribed antibiotics. The treatment of CAP due to Mycoplasma pneumoniae (Mp) is particularly problematic. Macrolide antibiotics are often used to treat for Mp, though the effectiveness of macrolides is unclear. In children, Mp produces 8-14% of CAP, though macrolides are prescribed at a much higher rate than the current incidence. A recent systematic review found no statistical difference in clinical improvement in children with Mp CAP who received macrolide therapy compared with beta-lactam antibiotics. Importantly, a substantial proportion of macrolide-treated children may have self-limiting Mp CAP or be Mp carriers with CAP caused by other pathogens.