A pediatric patient with community-acquired pneumonia (CAP) who has been started on antibiotic therapy needs to be monitored for evidence of an adequate response. The presence of an expected response indicates effective therapy, while failure indicates the need for further investigations. The authors are from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.


Patient selection: infant  > 3 months old or child with CAP


The time frame for evaluation is from start of therapy to 72 hours after starting.


Effective therapy is associated with a clinical response within 48-72 hours with:

(1) decrease fever

(2) normalizing respiratory rate

(3) improved oxygenation by pulse oximetry

(4) improvement in clinical appearance


A problem in the choice of therapy is indicated by:

(1) clinical deterioration

(2) absence of the signs given above for effective therapy by 72 hours after starting therapy

(3) failure of laboratory markers to improve (white blood cell count, CRP, etc)

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