Pneumonia (peds): Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pediatric fever DDX}} | |||
== Diagnosis == | == Diagnosis == | ||
Revision as of 22:32, 26 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
Clinical Features
Differential Diagnosis
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
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[2]
- 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[3]
- Initial outpatient management not recommended
1-3 Month
- Hospitalized[4]
- Afebrile pneumonitis
- Erythromycin (10 mg/kg q6) or Azithromycin (2.5 mg/kg q12)
- Febrile pneumonia
- Add Cefotaxime (200mg/kg per day divided q8h)
- Afebrile pneumonitis
- Outpatient[5]
- Erythromycin OR Azithromycin PO
>3mo - 18 years
- Hospitalized (PICU/severely ill)[6]
- Ceftriaxone IV AND Vancomycin AND consider Azithromycin
- Hospitalized (moderately ill)[7]
- Fully immunized: Ampicillin (50mg/kg q6) IV
- Not fully immunized: Ceftriaxone IV
- Outpatient[8]
- Amoxicillin (90 mg/kg divided BID) x 10 days PO
- Some studies have shown that 5 day course may also be adequate treatment
- Alternative: Clindamycin OR Azithromycin OR Amoxicillin-clavulanate
- Amoxicillin (90 mg/kg divided BID) x 10 days PO
Disposition
- All Children less than 2 months should be hospitalized[9]
- 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
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011