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 | ||
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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]] | ||
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**[[Bordetella pertussis]] | **[[Bordetella pertussis]] | ||
**[[Staphylococcus aureus]] | **[[Staphylococcus aureus]] | ||
* | *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 | *5–18 years | ||
**[[M. pneumoniae]] | **[[M. pneumoniae]] | ||
**[[S. pneumoniae]] | **[[S. pneumoniae]] | ||
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{{Pediatric fever DDX}} | {{Pediatric fever DDX}} | ||
== | ==Evaluation== | ||
*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity | *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 | ||
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''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: 2-3 months old | *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/respiratory distress | *Toxic appearance/respiratory distress | ||
*SpO2 <90-93% | *SpO2 <90-93% | ||
*Vomiting/dehydration | |||
*Unstable social environment | |||
==See Also== | ==See Also== |
Revision as of 17:49, 19 April 2018
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[2]
- 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[3]
- Initial outpatient management not recommended
1-3 Month
- Hospitalized[4]
- Afebrile pneumonitis
- Erythromycin (10 mg/kg q6) or Azithromycin (2.5 mg/kg q12)
- Febrile pneumonia
- Add Cefotaxime (200mg/kg per day divided q8h)
- Afebrile pneumonitis
- Outpatient[5]
- Erythromycin OR Azithromycin PO
>3mo - 18 years
- Hospitalized (PICU/severely ill)[6]
- Ceftriaxone IV AND Vancomycin AND consider Azithromycin
- Hospitalized (moderately ill)[7]
- Fully immunized: Ampicillin (50mg/kg q6) IV
- Not fully immunized: Ceftriaxone IV
- Outpatient[8]
- Amoxicillin (90 mg/kg divided BID) x 10 days PO
- Some studies have shown that 5 day course may also be adequate treatment
- Alternative: Clindamycin OR Azithromycin OR Amoxicillin-clavulanate
- Amoxicillin (90 mg/kg divided BID) x 10 days PO
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
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011