Pneumonia (peds): Difference between revisions
| Line 42: | Line 42: | ||
*Blood/nasal culture are low yield | *Blood/nasal culture are low yield | ||
== Treatment<ref | == Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
===Newborn=== | ===Newborn=== | ||
*Hospitalized | *Hospitalized | ||
**[[Ampicillin]] (80-90mg/kg/day) + | **[[Ampicillin]] (80-90mg/kg/day) + [[gentamicin]] +/- [[cefotaxime]] | ||
***Add [[vancomycin]] if [[MRSA]] a concern | |||
***Add [[erythromycin]] (12.g mg/kg QID) if concern for [[chlamydia]] | |||
*Outpatient | *Outpatient | ||
**Initial outpatient management not recommended | **Initial outpatient management not recommended | ||
| Line 52: | Line 54: | ||
*Hospitalized | *Hospitalized | ||
**Afebrile pneumonitis | **Afebrile pneumonitis | ||
***[[Erythromycin]] or [[ | ***[[Erythromycin]] (10 mg/kg q6) or [[azithro]] (2.5 mg/kg q12) | ||
**Febrile pneumonia | **Febrile pneumonia | ||
* | *Add [[cefoTAXime]] (200mg/kg per day divided q8h) | ||
*Outpatient | *Outpatient | ||
** | **[[erythromycin]] OR [[axithro]] PO | ||
=== | ===>3mo - 18 years=== | ||
*Hospitalized | *Hospitalized | ||
**[[Ampicillin]] | **Fully immunized: [[Ampicillin]] (50mg/kg q6) IV | ||
** | **Not fully immunized: [[cefoTAXime]] (150 mg/kg divided q8h) IV | ||
*Outpatient | *Outpatient | ||
**[[ | **[[Amoxicillin]] (90 mg/kg divided BID) x 5 days PO | ||
**Alternative: [[azithromycin]] OR [[amoxicillin-clavulanate]] | |||
==Disposition== | ==Disposition== | ||
Revision as of 09:02, 8 November 2014
Background
- Most common site of infection in neonates
- Fever and tachypnea are sensitive but not specific
Bugs by Age Group
- Newborn
- 1mo-3mo
- 3mo-5yr
- S. pneumoniae
- S. aureus
- H. influenzae type b
- Nontypeable H. influenzae
- C. trachomatis
- Mycoplasma pneumoniae
- 5–18 y
Diagnosis
- Absence of tachypnea, resp distress, and rales/decr BS rules-out with 100% sp
- Productive cough is rarely seen before late childhood
- Imaging
- CXR is not the gold standard!
- Cannot differentiate between viral and bact (but lobar infiltrate more often bacterial)
- Consider for:
- Age 0-3mo (part of w/u for sepsis)
- <5yr w/ temp >102.2, WBC >20K and no clear source of infection
- Ambiguous clinical findings
- PNA that is prolonged or not responsive to abx
- Consider rapid assays for RSV, influenza
- Blood/nasal culture are low yield
Treatment[1]
Newborn
- Hospitalized
- Ampicillin (80-90mg/kg/day) + gentamicin +/- cefotaxime
- Add vancomycin if MRSA a concern
- Add erythromycin (12.g mg/kg QID) if concern for chlamydia
- Ampicillin (80-90mg/kg/day) + gentamicin +/- cefotaxime
- Outpatient
- Initial outpatient management not recommended
1-3 Month
- Hospitalized
- Afebrile pneumonitis
- Erythromycin (10 mg/kg q6) or azithro (2.5 mg/kg q12)
- Febrile pneumonia
- Afebrile pneumonitis
- Add cefoTAXime (200mg/kg per day divided q8h)
- Outpatient
- erythromycin OR axithro PO
>3mo - 18 years
- Hospitalized
- Fully immunized: Ampicillin (50mg/kg q6) IV
- Not fully immunized: cefoTAXime (150 mg/kg divided q8h) IV
- Outpatient
- Amoxicillin (90 mg/kg divided BID) x 5 days PO
- Alternative: azithromycin OR amoxicillin-clavulanate
Disposition
- All Children less than 2 months should be hospitalized[2]
- Consider admission for:
- Age of birth to 3mo
- History of severe or relevant congenital disorders
- Immune suppression (HIV, SCD, malignancy)
- Toxic appearance/resp distress
- SpO2 <90-93%