Pneumonia (peds): Difference between revisions

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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>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
===Newborn===
{{Pediatric pneumonia treatment}}
*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]]
*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)
*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==
==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>
''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:
===Consider Admission For===
**Age of birth to 3mo
*Age: <2-3 months old
**History of severe or relevant congenital disorders
*History of severe or relevant congenital disorders
**Immune suppression (HIV, SCD, malignancy)
*Immune suppression (HIV, SCD, malignancy)
**Toxic appearance/resp distress
*Toxic appearance/respiratory distress
**SpO2 <90-93%
*SpO2 <90-93%
*Vomiting/dehydration
*Unstable social environment


==See Also==
==See Also==
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*[[Pediatric fever]]
*[[Pediatric fever]]


==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[9]

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