Pneumonia (peds): Difference between revisions
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*Blood/nasal culture are low yield | *Blood/nasal culture are low yield | ||
== Treatment | == 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>== | ||
===Newborn=== | |||
===1-3 Month=== | |||
===3mo - 5 year=== | |||
===5yr - 18yr=== | |||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- |
Revision as of 04:10, 14 October 2014
Background
- Most common site of infection in neonates
- Fever and tachypnea are Sensitive but not Specific
Causes
Neonatal
Age Group | Bacterial Pathogens | Hospitalized Patients | Outpatients |
---|---|---|---|
Newborn | Group B streptococci | Ampicillin | Initial outpatient management not recommended |
Gram-negative bacilli | plus | ||
Listeria monocytogenes | Gentamicin or cefotaxime | ||
1–3 mo | Streptococcus pneumoniae | Afebrile pneumonitis | Initial outpatient management not recommended |
Chlamydia trachomatis | Erythromycin or clarithromycin | ||
Haemophilus influenzae | Febrile pneumonia: | ||
Bordetella pertussis | Cefuroxime | ||
Staphylococcus aureus | ± erythromycin IV or clarithromycin PO | ||
Severe: choose one of | |||
Cefuroxime + erythromycin or clarithromycin | |||
Cefotaxime + erythromycin | |||
Cloxacillin + clarithromycin | |||
3 mo–5 y (majority of PNA in this group is viral) |
S. pneumoniae | Ampicillin IV or cefuroxime IV | Amoxicillin |
S. aureus | or amoxicillin if PO | or amoxicillin-clavulanate | |
H. influenzae type b |
or amoxicillin-clavulanate if PO | or cefuroxime axetil x7-10d | |
Nontypeable H. influenzae | Moderate to severe | ||
C. trachomatis | Add erythromycin or clarithromycin | ||
Mycoplasma pneumoniae | |||
5–18 y | M. pneumoniae | Ampicillin IV | Erythromycinor clarithromycin |
S. pneumoniae | plus | or amoxicillin ± clavulanate | |
C. pneumoniae | Erythromycin or clarithromycin | or cefuroxime axetil x7-10d | |
H. influenzae type b |
Alternative | ||
S. aureus | Cefuroxime | ||
or amoxicillin-clavulanate | |||
or erythromycin | |||
or clarithromycin | |||
Moderate to severe: | |||
Cefuroxime + erythromycin or clarithromycin |
Infants and Children
- More likely to have viral cause
- Consider secondary bacterial pneumonia if URI progresses to lower tract symptoms
- Pneumococus, H. flu, staph, pertussis
- If age >5 consider mycoplasma (treat w/ macrolide)
- Consider secondary bacterial pneumonia if URI progresses to lower tract symptoms
Bugs by Age Group
Age Group | Bacterial Pathogens | Hospitalized Patients | Outpatients |
---|---|---|---|
Newborn | Group B streptococci | Ampicillin | Initial outpatient management not recommended |
Gram-negative bacilli | plus | ||
Listeria monocytogenes | Gentamicin or cefotaxime | ||
1–3 mo | Streptococcus pneumoniae | Afebrile pneumonitis | Initial outpatient management not recommended |
Chlamydia trachomatis | Erythromycin or clarithromycin | ||
Haemophilus influenzae | Febrile pneumonia: | ||
Bordetella pertussis | Cefuroxime | ||
Staphylococcus aureus | ± erythromycin IV or clarithromycin PO | ||
Severe: choose one of | |||
Cefuroxime + erythromycin or clarithromycin | |||
Cefotaxime + erythromycin | |||
Cloxacillin + clarithromycin | |||
3 mo–5 y (majority of PNA in this group is viral) |
S. pneumoniae | Ampicillin IV or cefuroxime IV | Amoxicillin |
S. aureus | or amoxicillin if PO | or amoxicillin-clavulanate | |
H. influenzae type b |
or amoxicillin-clavulanate if PO | or cefuroxime axetil x7-10d | |
Nontypeable H. influenzae | Moderate to severe | ||
C. trachomatis | Add erythromycin or clarithromycin | ||
Mycoplasma pneumoniae | |||
5–18 y | M. pneumoniae | Ampicillin IV | Erythromycinor clarithromycin |
S. pneumoniae | plus | or amoxicillin ± clavulanate | |
C. pneumoniae | Erythromycin or clarithromycin | or cefuroxime axetil x7-10d | |
H. influenzae type b |
Alternative | ||
S. aureus | Cefuroxime | ||
or amoxicillin-clavulanate | |||
or erythromycin | |||
or clarithromycin | |||
Moderate to severe: | |||
Cefuroxime + erythromycin or clarithromycin |
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[1]
Newborn
1-3 Month
3mo - 5 year
5yr - 18yr
Age Group | Bacterial Pathogens | Hospitalized Patients | Outpatients |
---|---|---|---|
Newborn | Group B streptococci | Ampicillin | Initial outpatient management not recommended |
Gram-negative bacilli | plus | ||
Listeria monocytogenes | Gentamicin or cefotaxime | ||
1–3 mo | Streptococcus pneumoniae | Afebrile pneumonitis | Initial outpatient management not recommended |
Chlamydia trachomatis | Erythromycin or clarithromycin | ||
Haemophilus influenzae | Febrile pneumonia: | ||
Bordetella pertussis | Cefuroxime | ||
Staphylococcus aureus | ± erythromycin IV or clarithromycin PO | ||
Severe: choose one of | |||
Cefuroxime + erythromycin or clarithromycin | |||
Cefotaxime + erythromycin | |||
Cloxacillin + clarithromycin | |||
3 mo–5 y (majority of PNA in this group is viral) |
S. pneumoniae | Ampicillin IV or cefuroxime IV | Amoxicillin |
S. aureus | or amoxicillin if PO | or amoxicillin-clavulanate | |
H. influenzae type b |
or amoxicillin-clavulanate if PO | or cefuroxime axetil x7-10d | |
Nontypeable H. influenzae | Moderate to severe | ||
C. trachomatis | Add erythromycin or clarithromycin | ||
Mycoplasma pneumoniae | |||
5–18 y | M. pneumoniae | Ampicillin IV | Erythromycinor clarithromycin |
S. pneumoniae | plus | or amoxicillin ± clavulanate | |
C. pneumoniae | Erythromycin or clarithromycin | or cefuroxime axetil x7-10d | |
H. influenzae type b |
Alternative | ||
S. aureus | Cefuroxime | ||
or amoxicillin-clavulanate | |||
or erythromycin | |||
or clarithromycin | |||
Moderate to severe: | |||
Cefuroxime + erythromycin or clarithromycin |
- High dose amoxicillin (80-90mg/kg/day) is the first-line antibiotic of choice for uncomplicated outpatient community acquired pneumonia[1]
- For Inpatient treatment of pneumonia preference is to Vancomycin along with a second- or third- generation Cephalosporins.[1]
Disposition
- All Children less than 2 months should be hospitalized[1]
- 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%