Pneumonia (peds): Difference between revisions
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== Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | == Treatment<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
{{Pediatric pneumonia treatment}} | |||
==Disposition== | ==Disposition== | ||
Revision as of 22:24, 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
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)
- Hospitalized (moderately ill)
- Fully immunized: Ampicillin (50mg/kg/DOSE q6) IV (max: 2 g/DOSE)[10][11]
- Not fully immunized: Ceftriaxone (50 mg/kg/day q24h) IV (max: 2 g/DOSE)[12][13]
- Outpatient
- Amoxicillin (45 mg/kg/DOSE BID) x 5-7 days PO[14][15]
- Some studies have shown that 5 day course may also be adequate treatment
- Alternative: Clindamycin OR Azithromycin OR Amoxicillin-clavulanate
- Amoxicillin (45 mg/kg/DOSE BID) x 5-7 days PO[14][15]
Disposition
- All Children less than 2 months should be hospitalized[16]
- 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
- ↑ Harbor-UCLA ID Guidelines 2026
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Harbor-UCLA ID Guidelines 2026
- ↑ Harbor-UCLA ID Guidelines 2026
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Harbor-UCLA ID Guidelines 2026
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Harbor-UCLA ID Guidelines 2026
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ Harbor-UCLA ID Guidelines 2026
- ↑ AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011