Difference between revisions of "Pneumonia (peds)"

(5yr - 18yr)
(TreatmentAAP. 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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*Blood/nasal culture are low yield
 
*Blood/nasal culture are low yield
  
== 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>==
+
== Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
 
===Newborn===
 
===Newborn===
 
*Hospitalized
 
*Hospitalized
**[[Ampicillin]] (80-90mg/kg/day) + ([[gentamicin]] OR [[cefotaxime]])
+
**[[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
 
*Outpatient
 
**Initial outpatient management not recommended
 
**Initial outpatient management not recommended
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*Hospitalized
 
*Hospitalized
 
**Afebrile pneumonitis
 
**Afebrile pneumonitis
***[[Erythromycin]] or [[clarithromycin]]
+
***[[Erythromycin]] (10 mg/kg q6) or [[azithro]] (2.5 mg/kg q12)
 
**Febrile pneumonia
 
**Febrile pneumonia
***[[Cefuroxime]] ± ([[erythromycin]] IV or [[clarithromycin]] PO)
+
*Add [[cefoTAXime]] (200mg/kg per day divided q8h)
**Severe: choose one of
 
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]])
 
***[[Cefotaxime]] + [[erythromycin]]
 
***[[Cloxacillin]] + [[clarithromycin]]
 
 
*Outpatient
 
*Outpatient
**Initial outpatient management not recommended
+
**[[erythromycin]] OR [[axithro]] PO
 
 
===3mo - 5 year===
 
*Hospitalized
 
**Mild
 
***PO: [[Amoxicillin]] or [[Amoxicillin-clavulanate]]
 
***IV: [[Ampicillin]] or [[cefuroxime]]
 
**Moderate or severe
 
***([[Ampicillin]] or [[cefuroxime]]) + ([[erythromycin]] or [[clarithromycin]]) IV
 
*Outpatient
 
**[[Amoxicillin]] or [[amoxicillin-clavulanate]] or [[cefuroxime axetil]]
 
  
===5yr - 18yr===
+
===>3mo - 18 years===
 
*Hospitalized
 
*Hospitalized
**[[Ampicillin]] IV + ([[erythromycin]] OR [[clarithromycin]])
+
**Fully immunized:  [[Ampicillin]] (50mg/kg q6) IV
**Alternative: [[Cefuroxime]] or [[amoxicillin-clavulanate]] or [[erythromycin]] or [[clarithromycin]] 
+
**Not fully immunized: [[cefoTAXime]] (150 mg/kg divided q8h) IV
**Moderate to severe
 
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]])
 
 
*Outpatient
 
*Outpatient
**[[Erythromycin]] or [[clarithromycin]] or [[amoxicillin-clavulanate]] or [[cefuroxime axetil]]
+
**[[Amoxicillin]] (90 mg/kg divided BID) x 5 days PO
 +
**Alternative: [[azithromycin]] OR [[amoxicillin-clavulanate]]
  
 
==Disposition==
 
==Disposition==

Revision as of 09:02, 8 November 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 - 18 years

Disposition

  • All Children less than 2 months should be hospitalized[2]
  • 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. Sanford Guide to Antimicrobial Therapy 2014
  2. Cite error: Invalid <ref> tag; no text was provided for refs named AAP