Pneumonia (peds)

Background

• Most common site of infection in neonates
• Fever and tachypnea are sensitive but not specific

Bugs by Age Group

• Newborn
  • Group B streptococci
  • Gram-negative bacilli
  • Listeria monocytogenes
• 1mo-3mo
  • Streptococcus pneumoniae
  • Chlamydia trachomatis
  • Haemophilus influenzae
  • Bordetella pertussis
  • Staphylococcus aureus
• 3mo-5yr
  • S. pneumoniae
  • S. aureus
  • H. influenzae type b
  • Nontypeable H. influenzae
  • C. trachomatis
  • Mycoplasma pneumoniae
• 5–18 y
  • M. pneumoniae
  • S. pneumoniae
  • C. pneumoniae
  • H. influenzae type b
  • S. aureus

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

Newborn

• Hospitalized
  • Ampicillin (80-90mg/kg/day) + (gentamicin OR cefotaxime)
• Outpatient
  • Initial outpatient management not recommended

1-3 Month

• Hospitalized
  • Afebrile pneumonitis
    • Erythromycin or clarithromycin
  • Febrile pneumonia
    • Cefuroxime ± (erythromycin IV or clarithromycin PO)
  • Severe: choose one of
    • Cefuroxime + (erythromycin or clarithromycin)
    • Cefotaxime + erythromycin
    • Cloxacillin + clarithromycin
• Outpatient
  • Initial outpatient management not recommended

3mo - 5 year

• Hospitalized
  • Mild
    • PO: Amoxicillin or Amoxicillin-clavulanate
    • IV: Ampicillin or cefuroxime
  • Moderate or severe
    • (Ampicillin or cefuroxime) + (erythromycin or clarithromycin) IV
• Outpatient
  • Amoxicillin or amoxicillin-clavulanate or cefuroxime axetil

5yr - 18yr

• Hospitalized
  • Ampicillin IV + (erythromycin OR clarithromycin)
  • Alternative
    • Cefuroxime or amoxicillin-clavulanate or erythromycin or clarithromycin
  • Moderate to severe
    • Cefuroxime + (erythromycin or clarithromycin)
• Outpatient
  • Erythromycin or clarithromycin or amoxicillin or amoxicillin-clavulanate or cefuroxime axetil

Disposition

• All Children less than 2 months should be hospitalized
• 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%

See Also

• Pneumonia (Main)
• Pediatric fever