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.)
(Differential Diagnosis)
 
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== Background ==
+
{{Peds top}} [[pneumonia]]
 +
==Background==
 
*Most common site of infection in neonates
 
*Most common site of infection in neonates
*Fever and tachypnea are sensitive but not specific
 
  
 
===Bugs by Age Group===
 
===Bugs by Age Group===
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**[[Gram-negative bacilli]]
 
**[[Gram-negative bacilli]]
 
**[[Listeria monocytogenes]]
 
**[[Listeria monocytogenes]]
*1mo-3mo
+
*1-3 months
 
**[[Streptococcus pneumoniae]]  
 
**[[Streptococcus pneumoniae]]  
 
**[[Chlamydia trachomatis]]     
 
**[[Chlamydia trachomatis]]     
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**[[Bordetella pertussis]]   
 
**[[Bordetella pertussis]]   
 
**[[Staphylococcus aureus]]
 
**[[Staphylococcus aureus]]
*3mo-5yr
+
*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 y
+
*5–18 years
 
**[[M. pneumoniae]]   
 
**[[M. pneumoniae]]   
 
**[[S. pneumoniae]]   
 
**[[S. pneumoniae]]   
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**[[S. aureus]]
 
**[[S. aureus]]
  
== Diagnosis ==
+
==Clinical Features==
*Absence of tachypnea, resp distress, and rales/decr BS rules-out with 100% sp
+
''Fever and tachypnea are sensitive but not specific''
 +
*[[Fever]]
 +
*[[Cough]]
 
**Productive cough is rarely seen before late childhood
 
**Productive cough is rarely seen before late childhood
 +
 +
==Differential Diagnosis==
 +
{{Pediatric fever DDX}}
 +
{{Pediatric SOB DDX}}
 +
 +
==Evaluation==
 +
*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 bact (but lobar infiltrate more often bacterial)
+
**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
 
**Consider for:
 
**Consider for:
***Age 0-3mo (part of w/u for sepsis)
+
***Age 0-3mo (as part of sepsis workup)
***<5yr w/ temp >102.2, WBC >20K and no clear source of infection
+
***<5yr with temperature >102.2, WBC >20K and no clear source of infection
 
***Ambiguous clinical findings
 
***Ambiguous clinical findings
***PNA that is prolonged or not responsive to abx
+
***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
 +
**in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion <ref> Prevalence, risk factors, and outcomes of bacteremic pneumonia in children.  Pediatrics. 2019 Jun 19. </ref>
 +
**consider for sicker ones, those with effusions
  
== Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
+
==Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
===Newborn===
+
{{Pediatric pneumonia treatment}}
*Hospitalized
 
**[[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
 
**Initial outpatient management not recommended
 
 
 
===1-3 Month===
 
*Hospitalized
 
**Afebrile pneumonitis
 
***[[Erythromycin]] (10 mg/kg q6) or [[azithro]] (2.5 mg/kg q12)
 
**Febrile pneumonia
 
*Add [[cefoTAXime]] (200mg/kg per day divided q8h)
 
*Outpatient
 
**[[erythromycin]] OR [[axithro]] PO
 
 
 
===>3mo - 18 years===
 
*Hospitalized
 
**Fully immunized:  [[Ampicillin]] (50mg/kg q6) IV
 
**Not fully immunized: [[cefoTAXime]] (150 mg/kg divided q8h) IV
 
*Outpatient
 
**[[Amoxicillin]] (90 mg/kg divided BID) x 5 days PO
 
**Alternative: [[azithromycin]] OR [[amoxicillin-clavulanate]]
 
  
 
==Disposition==
 
==Disposition==
*All Children less than 2 months should be hospitalized<ref name="AAP"></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 of birth to 3mo
+
*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/resp distress
+
*Toxic appearance/respiratory distress
**SpO2 <90-93%
+
*SpO2 <90-93%
 +
*Vomiting/dehydration
 +
*Unstable social environment
  
 
==See Also==
 
==See Also==
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*[[Pediatric fever]]
 
*[[Pediatric fever]]
  
==Source==
+
==References==
 
<references/>
 
<references/>
  
[[Category:Peds]]
+
[[Category:Pediatrics]]
 
[[Category:ID]]
 
[[Category:ID]]
 +
[[Category:Pulmonary]]

Latest revision as of 16:18, 1 July 2020

This page is for pediatric patients. For adult patients, see: pneumonia

Background

  • Most common site of infection in neonates

Bugs by Age Group

Clinical Features

Fever and tachypnea are sensitive but not specific

  • Fever
  • Cough
    • Productive cough is rarely seen before late childhood

Differential Diagnosis

Pediatric fever

Pediatric Shortness of Breath

Pulmonary/airway

Cardiac

Other diseases with abnormal respiration

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 workup)
      • <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
    • in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion [1]
    • consider for sicker ones, those with effusions

Treatment[2]

Newborn

1-3 Month

>3mo - 18 years

Disposition

All Children less than 2 months should be hospitalized[3]

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

  1. Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019 Jun 19.
  2. Sanford Guide to Antimicrobial Therapy 2014
  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