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 | ||
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===Bugs by Age Group=== | ===Bugs by Age Group=== | ||
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**[[Gram-negative bacilli]] | **[[Gram-negative bacilli]] | ||
**[[Listeria monocytogenes]] | **[[Listeria monocytogenes]] | ||
| − | * | + | *1-3 months |
**[[Streptococcus pneumoniae]] | **[[Streptococcus pneumoniae]] | ||
**[[Chlamydia trachomatis]] | **[[Chlamydia trachomatis]] | ||
| Line 14: | Line 13: | ||
**[[Bordetella pertussis]] | **[[Bordetella pertussis]] | ||
**[[Staphylococcus aureus]] | **[[Staphylococcus aureus]] | ||
| − | * | + | *3 months-5 years |
**[[S. pneumoniae]] | **[[S. pneumoniae]] | ||
**[[S. aureus]] | **[[S. aureus]] | ||
| Line 21: | Line 20: | ||
**[[C. trachomatis]] | **[[C. trachomatis]] | ||
**[[Mycoplasma pneumoniae]] | **[[Mycoplasma pneumoniae]] | ||
| − | *5–18 | + | *5–18 years |
**[[M. pneumoniae]] | **[[M. pneumoniae]] | ||
**[[S. pneumoniae]] | **[[S. pneumoniae]] | ||
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**[[S. aureus]] | **[[S. aureus]] | ||
| − | == | + | ==Clinical Features== |
| − | * | + | ''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 | + | **Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial) |
**Consider for: | **Consider for: | ||
| − | ***Age 0-3mo (part of | + | ***Age 0-3mo (as part of sepsis work up) |
| − | ***<5yr | + | ***<5yr with temperature >102.2, WBC >20K and no clear source of infection |
***Ambiguous clinical findings | ***Ambiguous clinical findings | ||
| − | *** | + | ***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 | + | ==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== |
| − | + | {{Pediatric pneumonia treatment}} | |
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==Disposition== | ==Disposition== | ||
| − | + | ''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>'' | |
| − | + | ===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== | ==See Also== | ||
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*[[Pediatric fever]] | *[[Pediatric fever]] | ||
| − | == | + | ==References== |
<references/> | <references/> | ||
| − | [[Category: | + | [[Category:Pediatrics]] |
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 17:49, 19 April 2018
Contents
Background
- Most common site of infection in neonates
Bugs by Age Group
- Newborn
- 1-3 months
- 3 months-5 years
- S. pneumoniae
- S. aureus
- H. influenzae type b
- Nontypeable H. influenzae
- C. trachomatis
- Mycoplasma pneumoniae
- 5–18 years
Clinical Features
Fever and tachypnea are sensitive but not specific
Differential Diagnosis
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
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
- 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
- Add cefoTAXime (200mg/kg per day divided q8h)
- Afebrile pneumonitis
- Outpatient
- erythromycin OR azithro PO
>3mo - 18 years
- Hospitalized (PICU/severely ill)
- Ceftriaxone IV AND vancomycin AND consider azithromycin
- Hospitalized (moderately ill)
- Fully immunized: Ampicillin (50mg/kg q6) IV
- Not fully immunized: Ceftriaxone IV
- Outpatient
- Amoxicillin (90 mg/kg divided BID) x 5 days PO
- Alternative: clindamycin OR azithromycin OR amoxicillin-clavulanate
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
Authors:
Paolo Iacomini, Claire, Greg, Jordan Swartz, Neil Young, Daniel Ostermayer, robot, Ross Donaldson