S2k-Leitlinie Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)

M. A. Rose; M. Barker; J. Liese; O. Adams; T. Ankermann; U. Baumann; F. Brinkmann; R. Bruns; M. Dahlheim; S. Ewig; J. Forster; G. Hofmann; C. Kemen; C. Lück; D. Nadal; T. Nüßlein; N. Regamey; J. Riedler; S. Schmidt; N. Schwerk; J. Seidenberg; T. Tenenbaum; S. Trapp; M. van der Linden

doi:10.1055/a-1139-5132

Pneumologie 2020; 74(08): 515-544
DOI: 10.1055/a-1139-5132

Leitlinie

S2k-Leitlinie Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)^[*]

Federführend herausgegeben von der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) und der Gesellschaft für Pädiatrische Pneumologie (GPP)Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP)Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)

M. A. Rose^a^§

¹Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig

,

M. Barker^b^§

²Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin

,

J. Liese^c

³Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg

,

O. Adams^d

⁴Institut für Virologie, Universitätsklinikum Düsseldorf

,

T. Ankermann^a

⁵Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel

,

U. Baumann

⁶Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover

,

F. Brinkmann^e

⁷Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum

,

R. Bruns^b

⁸Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald

,

M. Dahlheim^f

⁹Praxis für Kinderpneumologie und Allergologie, Mannheim

,

S. Ewig^g

¹⁰Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne

,

J. Forster^e

¹¹Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen

,

G. Hofmann^h

¹²Kinderarztpraxis, Würzburg

,

C. Kemenⁱ

¹³Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg

,

C. Lück^j

¹⁴Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden

,

D. Nadal^k

¹⁵Kinderspital Zürich, Schweiz

,

T. Nüßlein^e

¹⁶Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz

,

N. Regamey^l

¹⁷Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz

,

J. Riedler^m

¹⁸Kinder- und Jugendmedizin, Kardinal Schwarzenberg’sches Krankenhaus, Schwarzach, Österreich

,

S. Schmidtⁿ

¹⁹Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald

,

N. Schwerkⁿ

²⁰Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover

,

J. Seidenberg

²¹Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg

,

T. Tenenbaum^b

²²Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim

,

S. Trapp^h

²³Kinderarztpraxis, Bremen

,

M. van der Linden^o

²⁴Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen

› Author Affiliations

Abstract

Zusammenfassung

Die vorliegende Fassung der deutschsprachigen AWMF-Leitlinie soll unter Berücksichtigung der vorliegenden Evidenz die medizinische Versorgung von Kindern und Jugendlichen mit ambulant erworbener Pneumonie (pediatric community acquired pneumonia, pCAP) verbessern. In Mitteleuropa steht einer Prävalenz von ca. 300 Fällen pro 100 000 Kinder/Jahr eine sehr geringe Mortalität gegenüber, die Prävention umfasst Hygiene-Maßnahmen und Impfung z. B. gegen Pneumokokken, Hämophilus, Masern und Influenza. Hauptsymptome der pCAP sind Fieber und Tachypnoe, die Diagnosestellung erfolgt primär klinisch durch Anamnese, körperliche Untersuchung und Pulsoxymetrie. Das zusätzliche Vorliegen von Warnsymptomen wie stark reduzierter Allgemeinzustand, Nahrungsverweigerung, Dehydratation, Bewusstseinsstörung oder Krampfanfälle definiert die schwere pCAP in Abgrenzung zur nicht-schweren pCAP. Das Erregerspektrum ist altersabhängig, zur Differenzierung zwischen viraler, bakterieller oder gemischt viral-bakterieller Infektion stehen jedoch keine zuverlässigen Biomarker zur Verfügung. Die meisten Kinder und Jugendlichen mit nicht-schwerer pCAP und O₂-Sättigung > 92 % können ohne weitere Röntgen-, Labor- und Erreger-Diagnostik ambulant betreut werden. Der Einsatz von Antiinfektiva ist nicht grundsätzlich indiziert, vor allem bei jungen Kindern, bronchialer Obstruktion und anderen Hinweisen auf virale Genese kann darauf i. d. R. verzichtet werden. Zur kalkulierten Antibiotika-Therapie sind Aminopenicilline Mittel der Wahl, bei gewährleisteter Einnahme und Resorption sind die orale (Amoxicillin) und intravenöse Verabreichung (Ampicillin) von vergleichbarer Wirksamkeit. Nach 48 – 72 Stunden ist eine Verlaufsbeurteilung notwendig, um den Behandlungserfolg und mögliche Komplikationen wie z. B. parapneumonische Ergüsse oder Pleuraempyeme, die eine Erweiterung bzw. Änderung der Therapie erforderlich machen, rechtzeitig zu erfassen.

Abstract

The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 – 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.

Full Text

References

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S2k-Leitlinie Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)[*]

S2k-Leitlinie Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)^[*]