21. Pneumonia in childhood. Flashcards
what is the etiology of pneumonia ? and what is the classification of common pathogens according to age groups ?
aspiration of airborne infected droplets
new born - b lactic group B strep (s agalactiae)
gram negative bacilli (Escherichia coli, Klebsiella species, Proteus species)
listeria monocytogen
herpes
1-3 months - chlamydia trachomatis
RSV
other respiratory viruses
3-12months RSV (and other respiratory viruses) strep pneumonia haemophilus influenza staph areas chlamydia trachomatis
2-5 years - RSV Parainfluenza Influenza strep pneumo homophiles influenza mycoplasma pneumonia chlamydia pneumonia
5-18 years - mycoplasma pneumonia strep pneumonia chlamydia pneumonia haemophlus influenza influenza A and B
sputum clinical characteristics of different pneumonia?
blood and pus sputum
Pseudomonas, Haemophilus, and pneumococcal species: May produce green sputum
Klebsiella species pneumonia: Red currant-jelly sputum
Anaerobic infections: Often produce foul-smelling or bad-tasting sputum
what are the signs and symptoms of pneumonia ?
TACHYPNEA IS THE MOST SENSITIVE AND SPECIFIC SIGN for pneumonia
<2months = >60bpm (severe infection
2 to 12 mon ths
25 to 40 - normal
Tachypnea - 50
1 to 7 years
22-30 -normal
Tachypnea -40
8-12 years old
18-30
Adults
12-20
Tachypnea - more than 20
diaphragmatic breathing
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cough
grunting - keeps narrow airways open = severe
nasal flaring - severe
hypoxemia - o2 saturation >95 percent
fever
more than 38.5C = severe
chest wall retractions and see saw breathing - complete (or almost) complete airway obstruction and stridor in calm child = severe pneumonia
cyanosis = severe
intermittent apnea = severe
not feeding
dehydration is a sign of severe infection
how can we differentiate between the bacterial and viral pneumonia ?
with classic signs
bacterial fever 40c or more productive cough chest pain WBC >13,000
viral fever less than 40 gradual onset of symptoms non productive cough headache myalgia fatigue rhinorrhea sore throat
infants and young children are less likely to have classic signs
they have fever , tachypnea , irritability , vomitting , diarrhea , poor feeding
how can we diagnose pneumonia ?
auscultation - rales : crackles at end of inspiration rhonchi - low pitch airway obstruction wheeze - high pitch - small airway obstruction decreased breath sounds
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chest X ray - gold standard
Pleural effusion on chest radiography is the most significant predictor of bacterial pneumonia
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rapid bedside testing including nasopharyngeal swab assays for influenza, respiratory syncytial virus
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cbc
↑ Serum procalcitonin (PCT): Procalcitonin is an acute phase reactant that can help to diagnose bacterial lower respiratory tract
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electrolytes - PARTICULARLY SODIUM
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sputum culture- rarely produced in children less than 10 years
not productive as the samples are often contaminated by oral flora
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blood culture - can be done but are often negative
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MOST OFTEN NOW
mycoplasma serology
legionella, and chlamydia species
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TB skin test
Pleural fluid culture
Bronchoscope
what is the general treatment for pneumonia ?
infants less than 3 months - with signs of pneumonia urgent referral to hospital because high risk of illness
or infants with malnutrition , and congenital heart disease and chronic lung disease
empiric treatment OF COMMUNITY ACQUIRED PNEUMONIA :
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newborn
ampicillin +
+- gentamicin
+- erythromycin (if afebrile)
{ Ampicillin IV / IM
Age>7 days:
Weight <2 kg : 50 - 100 mg/ kg / day q 12 hours
Weight ≥2 kg: 75 - 150 mg/ kg / day q8 hours
gentamicin IV/IM
2.5 mg/ kg / 8 hours
Erythromycin IV, 40 mg /kg /day q6 hours
icu same
outpatient not recommended
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1-3months
cefuroxime / cefotaxim
Cefuroxime ,
150 mg /kg / day IV in divided doses every 8 hours
in ICU - Cefotaxime IV, 200 mg / kg / day IV in divided doses every 8 hours plus cloxacillin IV, 150 - 200 mg /kg /day q 6 hours or Cefuroxime IV alone, 150 mg / kg /day q8 hours
outpatient not recommended
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3 months to 5 years (majority resp viruses - antimicrobial therapy not recommended unless bacterial etiology)
Cefotaxime, 150 mg / kg per day IV in q 6 hours*
Cefuroxime, 150 mg /kg per day IV in q 8 hours
*or
If the patient has pneumococcal infection: Ampicillin alone, 200 mg / kg /day IV q8 hours
ICU - cefurozime (same dose) + erythromycin (same dose above) for 10-14 days
outpatient amoxicillin
Amoxicillin orally , 90 mg /kg /day orally q8 hours
for 7 - 10 days
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5-18 years (lobar pneumonia - strep pneumonia
erythromycin
+
cefuroxime
Cefuroxime, 150 mg /kg per day IV in q 8 hours
Erythromycin, 40 mg / kg / day IV q6hrs
for 10 to 14 days
pneumococcal - as above
ICU
cefuroxime and erythromycin (same as above)
outpatient - erythromycin oral
(same dose as above)
all usually 7-day to 10-day antibiotic courses
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supportive treatmnet with oxygen therapy
if severe >39 degrees paracetamol
if wheeze - rapid acting bronchodilator - SABA
gentle suction of any secretion in the throat
NG if the child cannot drink
encourage breastfeeding and oral fluids
avoid dehydration
what is the treatment for s agalactiae pneumonia (or group B strep)
penicillin G Ten days of therapy IV
450,000–500,000 units/kg/day for infants older than 7 days
what is the treatment forC. trachomatis pneumonia ?
erythromycin (doses given)
what is the treatment for RSV pneumonia?
nasal suction
nasal decongestion
ntipyretics for fever - acetaminophen
ribavirin - aerosolized form
what is the treatment of strep pneumonia
amoxicillin
amoxicillin 90 mg/kg/day in 2 doses or
45 mg/kg/day in 3 doses
for 10 days
what is the treatment of haemophilus influenza
amoxicillin (90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses)
amoxicillin/clavulanate,
azithromycin,
≥6 months: 10 mg/kg PO x 1 dose on Day 1, followed by 5 mg/kg PO on Days 2-5
oral suspension
cephalosporins
what is the treatment of staph areas
ceftriaxone IM or slow IV
+
cloxacillin IV infusion
Children 1 month and over: 25 to 50 mg/kg every 6 hours
After clinical improvement3 , 3 days with no fever, and drain removal if any, switch to amoxicillin/clavulanic acid PO to complete 10 to 14 days
what is the treatment of mycoplasma pneumonia
MP infection is usually mild and self-limited, without a need for a specific treatment.
Because MP has no cell wall, antibiotics such as macrolides, tetracyclines, and quinolones have been used for treating MP pneumonia.
For children, only macrolides (erythromycin, clarithromycin, roxithromycin, and azithromycin) are used because of the potential side effects of alternative drugs (tetracycline and fluoroquinolones)
what is the treatment of chlamydia pneumonia
azithromycin
≥6 months: 10 mg/kg PO x 1 dose on Day 1, followed by 5 mg/kg PO on
what are the complications of pneumonia ?
pleural effusion
empyema
parapenumonic effusions
necrotising pneumonia
lung abcess
pneumocetele
hyponatremia
associated with increased hospital stays , mortality
