Lobar Pneumonia
>>4 most likely causes: #1 = s pneumo, h influ, GAS (s pyogenes), s aureus (not common but important to think about)

Tx - most commonly s pneumo so send home on amoxi
>>even if admit b/c vomiting, give ampi because still targeting s pneumo

Acute bacterial pneumonia
>>other possible causes: Mycobacterium tuberculosis, RSV, Influenza A/B, adenovirus, etc

Microbiologic diagnosis
>>Blood cultures are insensitive (positive in < 20%)
>>Sputum culture (hard to get & usually contaminated with mouth bugs)
>>pleural fluid PCR - can specifically ask for s pneumo, or do pan-analysis for multiple

Empiric therapy for hospitalized children with uncomplicated pneumonia
>>Non-life threatening - ampicillin
>>Respiratory failure or septic shock - Ceftriaxone ± vancomycin (broader coverage)
-Main pathogen being targeted is S. pneumoniae
-Ceftriaxone offers better coverage against β-lactamase+ H. influenzae & possibly for S. pneumoniae with high level resistance to penicillin
-vanco for s aureus coverage (tend to be much sicker, tend to have abscesses)
-If influenza virus detected, strongly consider oseltamivir or zanamavir