King et al listed criteria for treatment failure in a child with community-acquired pneumonia (CAP). This can help to identify a patient who may benefit from more aggressive management. The authors are from the University College London, Johns Hopkins University, McGill University, Kaiser Permanente Northwest, Bill and Melinda Gates Foundation and government agencies of Malawi.


Patient selection: pediatric patient with fast-breathing community-acquired pneumonia, age 2 to 59 months, who has been treated with oral antibiotics


Fast breathing pneumonia:

(1) cough and/or difficulty breathing

(2) fast breathing (> 50 breaths per minute for 2-11 months, > 40 breaths per minute for 12 to 59 months)


Time of assessment: day after final dose of oral antibiotics


Criteria for treatment failure – one or more of the following:

(1) fast breathing for age

(2) axillary temperature > 37.5°C

(3) indrawing of the lower chest

(4) vomiting everything

(5) unable to feed

(6) convulsions in the previous 24 hours

(7) sleepy or unconscious

(8) oxygen saturation < 90%

(9) grunting

(10) nasal flaring

(11) head nodding

(12) need to change antibiotic due to disease progression

(13) hospital admission

(14) death


To read more or access our algorithms and calculators, please log in or register.