Pneumonia (peds)
Revision as of 12:39, 14 October 2014 by Rossdonaldson1 (talk | contribs)
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 OR cefotaxime)
- Outpatient
- Initial outpatient management not recommended
1-3 Month
- Hospitalized
- Afebrile pneumonitis
- Febrile pneumonia
- Cefuroxime ± (erythromycin IV or clarithromycin PO)
- Severe: choose one of
- Outpatient
- Initial outpatient management not recommended
3mo - 5 year
- Hospitalized
- Mild
- PO: Amoxicillin or Amoxicillin-clavulanate
- IV: Ampicillin or cefuroxime
- Moderate or severe
- (Ampicillin or cefuroxime) + (erythromycin or clarithromycin) IV
- Mild
- Outpatient
5yr - 18yr
- Hospitalized
- Ampicillin IV + (erythromycin OR clarithromycin)
- Alternative
- Moderate to severe
- Cefuroxime + (erythromycin or clarithromycin)
- Outpatient
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%