Difference between revisions of "Pneumonia (peds)"

(Disposition)
(5yr - 18yr)
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*Hospitalized
 
*Hospitalized
 
**[[Ampicillin]] IV + ([[erythromycin]] OR [[clarithromycin]])
 
**[[Ampicillin]] IV + ([[erythromycin]] OR [[clarithromycin]])
**Alternative
+
**Alternative: [[Cefuroxime]] or [[amoxicillin-clavulanate]] or [[erythromycin]] or [[clarithromycin]]   
***[[Cefuroxime]] or [[amoxicillin-clavulanate]] or [[erythromycin]] or [[clarithromycin]]   
 
 
**Moderate to severe
 
**Moderate to severe
 
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]])
 
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]])
 
*Outpatient
 
*Outpatient
**[[Erythromycin]] or [[clarithromycin]] or [[amoxicillin]] or [[amoxicillin-clavulanate]] or [[cefuroxime axetil]]
+
**[[Erythromycin]] or [[clarithromycin]] or [[amoxicillin-clavulanate]] or [[cefuroxime axetil]]
  
 
==Disposition==
 
==Disposition==

Revision as of 13:08, 14 October 2014

Background

  • Most common site of infection in neonates
  • Fever and tachypnea are sensitive but not specific

Bugs by Age Group

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

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%

See Also

Source

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