Pneumonia (peds): Difference between revisions
| Line 75: | Line 75: | ||
*Hospitalized | *Hospitalized | ||
**[[Ampicillin]] IV + ([[erythromycin]] OR [[clarithromycin]]) | **[[Ampicillin]] IV + ([[erythromycin]] OR [[clarithromycin]]) | ||
**Alternative | **Alternative: [[Cefuroxime]] or [[amoxicillin-clavulanate]] or [[erythromycin]] or [[clarithromycin]] | ||
**Moderate to severe | **Moderate to severe | ||
***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]]) | ***[[Cefuroxime]] + ([[erythromycin]] or [[clarithromycin]]) | ||
*Outpatient | *Outpatient | ||
**[[Erythromycin]] or [[clarithromycin | **[[Erythromycin]] or [[clarithromycin]] or [[amoxicillin-clavulanate]] or [[cefuroxime axetil]] | ||
==Disposition== | ==Disposition== | ||
Revision as of 13:08, 14 October 2014
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: Cefuroxime or amoxicillin-clavulanate or erythromycin or clarithromycin
- 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%