Pediatric Criteria for Nonresponse to Therapy for Community Acquired Pneumonia (CAP)

Number of hours since starting the current therapeutic regimen

• a fever that is persistent or getting worse?

• persistent tachycardia?

• continued signs of respiratory insufficiency (tachypnea, grunting, cyanosis, chest retractions)?

• oxygen saturation < 90% on room air?

• a need for supplemental oxygen or ventilatory support?

• abnormal chest findings on physical exam (abnormal or absent breath sounds, dullness to percussion)?

• a toxic appearance on physician assessment?

• an altered mental status?

• chest pain or splinting of chest?

• an inability to eat or drink sufficient to meet basic needs?

• continued leukocytosis and/or left shift with immature neutrophils?

• persistent elevation in CRP and procalcitonin?

• laboratory tests continued positive for pathogens?

• evidence of increased parenchymal involvement on imaging studies?

• persistent or increasing pleural fluid on imaging studies?