Difference between revisions of "Pneumonia (peds)"

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== Background ==
+
==Background==
 
*Most common site of infection in neonates
 
*Most common site of infection in neonates
*Fever and tachypnea are sensitive but not specific
 
  
 
===Bugs by Age Group===
 
===Bugs by Age Group===
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**[[Gram-negative bacilli]]
 
**[[Gram-negative bacilli]]
 
**[[Listeria monocytogenes]]
 
**[[Listeria monocytogenes]]
*1mo-3mo
+
*1-3 months
 
**[[Streptococcus pneumoniae]]  
 
**[[Streptococcus pneumoniae]]  
 
**[[Chlamydia trachomatis]]     
 
**[[Chlamydia trachomatis]]     
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**[[Bordetella pertussis]]   
 
**[[Bordetella pertussis]]   
 
**[[Staphylococcus aureus]]
 
**[[Staphylococcus aureus]]
*3mo-5yr
+
*3 months-5 years
 
**[[S. pneumoniae]]   
 
**[[S. pneumoniae]]   
 
**[[S. aureus]]   
 
**[[S. aureus]]   
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**[[C. trachomatis]]   
 
**[[C. trachomatis]]   
 
**[[Mycoplasma pneumoniae]]   
 
**[[Mycoplasma pneumoniae]]   
*5–18 y
+
*5–18 years
 
**[[M. pneumoniae]]   
 
**[[M. pneumoniae]]   
 
**[[S. pneumoniae]]   
 
**[[S. pneumoniae]]   
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**[[S. aureus]]
 
**[[S. aureus]]
  
== Diagnosis ==
+
==Clinical Features==
*Absence of tachypnea, resp distress, and rales/decr BS rules-out with 100% sp
+
''Fever and tachypnea are sensitive but not specific''
 +
*[[Fever]]
 +
*[[Cough]]
 
**Productive cough is rarely seen before late childhood
 
**Productive cough is rarely seen before late childhood
 +
 +
==Differential Diagnosis==
 +
{{Pediatric fever DDX}}
 +
 +
==Evaluation==
 +
*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
 
*Imaging
 
*Imaging
**CXR is not the gold standard!
+
**[[CXR]] is not the gold standard!
**Cannot differentiate between viral and bact (but lobar infiltrate more often bacterial)
+
**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
 
**Consider for:
 
**Consider for:
***Age 0-3mo (part of w/u for sepsis)
+
***Age 0-3mo (as part of sepsis work up)
***<5yr w/ temp >102.2, WBC >20K and no clear source of infection
+
***<5yr with temperature >102.2, WBC >20K and no clear source of infection
 
***Ambiguous clinical findings
 
***Ambiguous clinical findings
***PNA that is prolonged or not responsive to abx
+
***Pneumonia that is prolonged or not responsive to antibiotics
*Consider rapid assays for RSV, influenza
+
*Consider rapid assays for RSV, [[influenza]]
 
*Blood/nasal culture are low yield
 
*Blood/nasal culture are low yield
  
== Treatment<ref name="AAP">AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011.</ref>==
+
==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
===Newborn===
+
{{Pediatric pneumonia treatment}}
*Hospitalized
 
**[[Ampicillin]] (80-90mg/kg/day) + ([[gentamicin]] OR [[cefotaxime]])
 
*Outpatient
 
**Initial outpatient management not recommended
 
  
===1-3 Month===
+
==Disposition==
*Hospitalized
+
''All Children less than 2 months should be hospitalized<ref>AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011</ref>''
**Afebrile pneumonitis
+
===Consider Admission For===
***[[Erythromycin]] or [[clarithromycin]]
+
*Age: <2-3 months old
**Febrile pneumonia
+
*History of severe or relevant congenital disorders
***[[Cefuroxime]] ± ([[erythromycin]] IV or [[clarithromycin]] PO)
+
*Immune suppression (HIV, SCD, malignancy)
**Severe: choose one of
+
*Toxic appearance/respiratory distress
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]])
+
*SpO2 <90-93%
***[[Cefotaxime]] + [[erythromycin]]
+
*Vomiting/dehydration
***[[Cloxacillin]] + [[clarithromycin]]
+
*Unstable social environment
*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===
+
==See Also==
*Hospitalized
+
*[[Pneumonia (Main)]]
**[[Ampicillin]] IV + ([[erythromycin]] OR [[clarithromycin]])
+
*[[Pediatric fever]]
**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<ref name="AAP"></ref>
 
*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%
 
  
==Source==
+
==References==
 
<references/>
 
<references/>
  
[[Category:Peds]]
+
[[Category:Pediatrics]]
 
[[Category:ID]]
 
[[Category:ID]]

Revision as of 17:49, 19 April 2018

Background

  • Most common site of infection in neonates

Bugs by Age Group

Clinical Features

Fever and tachypnea are sensitive but not specific

  • Fever
  • Cough
    • Productive cough is rarely seen before late childhood

Differential Diagnosis

Pediatric fever

Evaluation

  • Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
  • Imaging
    • CXR is not the gold standard!
    • Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
    • Consider for:
      • Age 0-3mo (as part of sepsis work up)
      • <5yr with temperature >102.2, WBC >20K and no clear source of infection
      • Ambiguous clinical findings
      • Pneumonia that is prolonged or not responsive to antibiotics
  • Consider rapid assays for RSV, influenza
  • Blood/nasal culture are low yield

Treatment[1]

Newborn

1-3 Month

>3mo - 18 years

Disposition

All Children less than 2 months should be hospitalized[2]

Consider Admission For

  • Age: <2-3 months old
  • History of severe or relevant congenital disorders
  • Immune suppression (HIV, SCD, malignancy)
  • Toxic appearance/respiratory distress
  • SpO2 <90-93%
  • Vomiting/dehydration
  • Unstable social environment

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014
  2. AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011