Pneumonia (peds): Difference between revisions
m (Rossdonaldson1 moved page Pneumonia (Peds) to Pneumonia (peds)) |
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*Add [[cefoTAXime]] (200mg/kg per day divided q8h) | *Add [[cefoTAXime]] (200mg/kg per day divided q8h) | ||
*Outpatient | *Outpatient | ||
**[[erythromycin]] OR [[ | **[[erythromycin]] OR [[azithro]] PO | ||
===>3mo - 18 years=== | ===>3mo - 18 years=== |
Revision as of 19:27, 25 May 2015
Background
- Most common site of infection in neonates
- Fever and tachypnea are sensitive but not specific
Bugs by Age Group
- Newborn
- 1mo-3mo
- 3mo-5yr
- S. pneumoniae
- S. aureus
- H. influenzae type b
- Nontypeable H. influenzae
- C. trachomatis
- Mycoplasma pneumoniae
- 5–18 y
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
- 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
- Ampicillin (80-90mg/kg/day) + gentamicin +/- cefotaxime
- 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
- Afebrile pneumonitis
- Add cefoTAXime (200mg/kg per day divided q8h)
- Outpatient
- erythromycin OR azithro 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
- 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%