Defining the aetiology of paediatric community-acquired pneumonia: an unsolved problem

Introduction: Pediatric community-acquired pneumonia (CAP) remains a significant health problem worldwide. Although knowledge in the etiology of CAP is not satisfactory, in most cases, therapy is decided following probability-based criteria that are derived from studies that report the frequency of detection of pathogens in children with CAP. Areas covered: This narrative review discusses the present knowledge on pediatric CAP etiology, the limits of the aetiological studies and the tests for differentiation of viral from bacterial infections. Expert commentary: The type of therapeutic approach in pediatric CAP is chosen considering the risk of bacterial etiology and the pathogens most frequently detected in the different pediatric ages. Fear of the potential negative course of unrecognized and untreated bacterial CAP is the main reason for the large use of antibiotics. Unfortunately, the antibiotic prescription is unnecessary in most of the cases as it can favor the emergence of resistant strains and can increase the number of drug-related adverse events. However, it is likely that a significant reduction of antibiotic prescriptions will occur when point-of-care tests with biomarkers for differentiation viral from bacterial infections become available.