Difference between revisions of "Pneumonia (peds)"

(TreatmentAAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011.)
(TreatmentAAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011.)
Line 273: Line 273:
 
===Newborn===
 
===Newborn===
 
*Hospitalized
 
*Hospitalized
**[[Ampicillin]] + ([[gentamycin]] OR [[cefotaxime]])
+
**[[Ampicillin]] (80-90mg/kg/day) + ([[gentamicin]] OR [[cefotaxime]])
 
*Outpatient
 
*Outpatient
 
**Initial outpatient management not recommended
 
**Initial outpatient management not recommended
  
 
===1-3 Month===
 
===1-3 Month===
 +
*Hospitalized
 +
**Afebrile pneumonitis
 +
***[[Erythromycin]] or [[clarithromycin]]
 +
**Febrile pneumonia
 +
***[[Cefuroxime]] ± ([[erythromycin]] IV or [[clarithromycin]] PO)
 +
**Severe: choose one of
 +
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]])
 +
***[[Cefotaxime]] + [[erythromycin]]
 +
***[[Cloxacillin]] + [[clarithromycin]]
 +
*Outpatient
 +
**Initial outpatient management not recommended
  
 
===3mo - 5 year===
 
===3mo - 5 year===
 +
*Hospitalized
 +
**Ampicillin IV or cefuroxime IV
 +
**or amoxicillin if PO
 +
**or amoxicillin-clavulanate if PO
 +
**Moderate or severe
 +
***Add erythromycin or clarithromycin
 +
*Outpatient
 +
**Amoxicillin
 +
**or amoxicillin-clavulanate
 +
**or cefuroxime axetil x7-10d
  
 
===5yr - 18yr===
 
===5yr - 18yr===
 +
*Hospitalized
 +
**Ampicillin IV + (erythromycin OR clarithromycin)
 +
**Alternative
 +
***Cefuroxime or amoxicillin-clavulanate or erythromycin or clarithromycin 
 +
**Moderate to severe
 +
***Cefuroxime + (erythromycin or clarithromycin)
 +
*Outpatient
 +
**Erythromycinor clarithromycin
 +
**or amoxicillin ± clavulanate
 +
**or cefuroxime axetil x7-10d
  
{| class="wikitable"
+
===Comments===
|-
 
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Age Group
 
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Bacterial Pathogens
 
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Hospitalized Patients
 
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Outpatients
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Newborn
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Group B streptococci
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Ampicillin
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Initial outpatient management not recommended
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Gram-negative bacilli
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''plus'' 
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Listeria monocytogenes'' 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Gentamicin ''or'' cefotaxime
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="9" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 1–3 mo
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Streptococcus pneumoniae'' 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Afebrile pneumonitis
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="9" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Initial outpatient management not recommended
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Chlamydia trachomatis'' 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |   Erythromycin ''or ''clarithromycin
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Haemophilus influenzae'' 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Febrile pneumonia:
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Bordetella pertussis'' 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |   Cefuroxime
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Staphylococcus aureus'' 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |   ± erythromycin IV ''or ''clarithromycin PO
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |  
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Severe: choose one of
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |  
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |   Cefuroxime + erythromycin ''or'' clarithromycin
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |  
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |   Cefotaxime + erythromycin
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |  
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;Cloxacillin&nbsp;+ clarithromycin<br/>&nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="6" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
 
3 mo–5 y
 
 
 
(majority of PNA
 
 
 
in this group is
 
 
 
viral)
 
 
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''S. pneumoniae''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Ampicillin IV''&nbsp;or''&nbsp;cefuroxime IV
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Amoxicillin
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''S. aureus''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or&nbsp;''amoxicillin if PO
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or''&nbsp;amoxicillin-clavulanate
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''H. influenzae''&nbsp;type b<br/>&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or''&nbsp;amoxicillin-clavulanate if PO
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or''&nbsp;cefuroxime axetil x7-10d
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Nontypeable&nbsp;''H. influenzae''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Moderate to severe
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''C. trachomatis''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;''Add&nbsp;''erythromycin or clarithromycin
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Mycoplasma pneumoniae''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="10" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 5–18 y
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''M. pneumoniae''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Ampicillin IV
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Erythromycin''or''&nbsp;clarithromycin<br/>&nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''S. pneumoniae''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''plus''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or''&nbsp;amoxicillin ± clavulanate
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''C. pneumoniae''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Erythromycin&nbsp;''or''&nbsp;clarithromycin
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or''&nbsp;cefuroxime axetil&nbsp;x7-10d
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''H. influenzae''&nbsp;type b<br/>&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''Alternative''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''S. aureus''&nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;Cefuroxime
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;''or&nbsp;''amoxicillin-clavulanate
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;''or''&nbsp;erythromycin
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;''or''&nbsp;clarithromycin
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Moderate to severe:
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;&nbsp;Cefuroxime&nbsp;''+''&nbsp;erythromycin&nbsp;''or''&nbsp;clarithromycin
 
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | &nbsp;
 
|}
 
 
 
 
*High dose amoxicillin (80-90mg/kg/day) is the first-line antibiotic of choice for uncomplicated outpatient community acquired pneumonia<ref name="AAP"></ref>
 
*High dose amoxicillin (80-90mg/kg/day) is the first-line antibiotic of choice for uncomplicated outpatient community acquired pneumonia<ref name="AAP"></ref>
 
*For Inpatient treatment of pneumonia preference is to [[Vancomycin]] along with a second- or third- generation [[Cephalosporins]].<ref name="AAP"></ref>
 
*For Inpatient treatment of pneumonia preference is to [[Vancomycin]] along with a second- or third- generation [[Cephalosporins]].<ref name="AAP"></ref>

Revision as of 11:58, 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)

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

  • Hospitalized
    • Ampicillin IV or cefuroxime IV
    • or amoxicillin if PO
    • or amoxicillin-clavulanate if PO
    • Moderate or severe
      • Add erythromycin or clarithromycin
  • Outpatient
    • Amoxicillin
    • or amoxicillin-clavulanate
    • or cefuroxime axetil x7-10d

5yr - 18yr

  • Hospitalized
    • Ampicillin IV + (erythromycin OR clarithromycin)
    • Alternative
      • Cefuroxime or amoxicillin-clavulanate or erythromycin or clarithromycin
    • Moderate to severe
      • Cefuroxime + (erythromycin or clarithromycin)
  • Outpatient
    • Erythromycinor clarithromycin
    • or amoxicillin ± clavulanate
    • or cefuroxime axetil x7-10d

Comments

  • 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%

Source

  1. 1.0 1.1 1.2 1.3 AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011.