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PHM 704- Pediatrics > CAP > Flashcards

CAP Flashcards

1
Q

Risk factors for pediatric CAP

A

Recent history of URTI- viral respiratory prodrome
Lower socioeconomic status
Crowded living environment
Exposure to cigarette smoking
Comorbidities

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2
Q

Comorbidities for CAP

A

ASTHMA
Bronchopulmonary dysplasia
CF
Sickle cell disease
Congenital heart disease

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3
Q

Bacterial causes of CAP

A

Strep. pneumoniae- MOST COMMON PATHOGEN
H. influenzae
S. aureus
Group A Strep

Atypical (3-23%, mostly in older children):
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella (rare)

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4
Q

Viral causes of CAP

A

Influenza virus
RSV
PIV
Adenovirus
Rhinovirus

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5
Q

Viral agents are more common in what age group?

A

<2 years old, makes up ~80% of CAP cases in this population

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6
Q

Best predictor of cause via identification of likely pathogen and exposure

A

AGE

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7
Q

Suspected CAP pathogens: birth-20 days

A

GBS
Gram-negative enteric bacteria
L. monocytogenes

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8
Q

Suspected CAP pathogens: 3 weeks-3 months

A

S. pneumoniae
S. aureus
RSV
PIV
B. pertussis
C. trachomatis

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9
Q

Suspected CAP pathogens: 4 months-4 years

A

S. pneumoniae
H. influenzae
M. pneumoniae
Viruses
M. tuberculosis

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10
Q

Suspected pathogens: 5 years-15 years

A

S. pneumoniae
H. influenzae
M. pneumoniae
C. pneumoniae
Influenza A or B, adenovirus
M. tuberculosis

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11
Q

Outpatient CAP: <5 years old, presumed bacterial pneumonia, 1st-line option

A

Amoxicillin 90mg/kg/d PO div. BID or TID, MDD 3-4g/day

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12
Q

Reason a high dose of amoxicillin is used

A

Overcome S. pneumonia’s mechanism of resistance (production of PCN-binding protein)

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13
Q

Outpatient CAP: <5 years old, presumed bacterial pneumonia, alternative

A

Amox/clav 90mg/kg/day div. BID or TID, MDD= 875-1000mg/dose

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14
Q

What is the clavulanate there to do in amox/clav?

A

Cover the beta-lactamase producing organisms

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15
Q

ES formulations of amox/clav do what?

A

Increase the amoxicillin component without increasing the clav. component, which may increase diarrhea

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16
Q

Outpatient CAP: <5 years old, presumed atypical pneumonia, 1st-line option

A

Azithromycin 10mg/kg/day PO on day 1 (MDD=500mg), then Azithromycin 5mg/kg/day PO on days 2-5 (MDD=250mg)

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17
Q

Reason azithromycin course is only 5 days

A

Long half-life with post-ABX effect

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18
Q

Outpatient CAP: <5 years old, presumed atypical pneumonia, alternative

A

Clarithromycin 15mg/kg/day in 2 doses x7-14 days OR erythromycin 40mg/kg/day in 4 doses

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19
Q

Outpatient CAP: <5 years old, presumed influenza pneumonia, 1st-line option

A

oseltamivir x5 days, but only effective if initiated within 48 hours of symptoms

20
Q

Outpatient CAP: ≥5 years old, presumed bacterial pneumonia, 1st-line option

A

Amoxicillin 90mg/kg/day (like in patients <5 years old)

Can add macrolide to beta-lactam ABX for empiric therapy if there’s not enough evidence to distinguish between this and atypical CAP

21
Q

Outpatient CAP: ≥5 years old, presumed bacterial pneumonia, alternate

A

Amox/clav (like in patients <5 years old)

22
Q

Outpatient CAP: ≥5 years old, presumed atypical pneumonia, 1st-line option

A

Amox/clav, like in patients <5

23
Q

Outpatient CAP: ≥5 years old, presumed atypical pneumonia, alternates

A

erythromycin, doxycycline in kids >7

24
Q

Outpatient CAP: ≥5 years old, presumed influenza pneumonia

A

oseltamivir or zanamivir for children ≥7

25
Q

Inpatient CAP, fully immunized, MIC ≤2: presumed bacterial pneumonia

A

Ampicillin (or PCN G) 150-200mg/kg/day IV div. q6h, MDD=2g/dose
^empiric dose or S. pneumonia, H. influenzae

Group A Strep: 200mg/kg/day IV div. q6h

S. pneumoniae when PCN MIC is ≥4: 300-400mg/kg/day IV div q6h, MDD= 12g/day

26
Q

Ampicillin ADEs

A

diarrhea, rash, eosinophilia

27
Q

Ampicillin alternatives

A

ceftriaxone, cefotaxime, adding vanco or clindamycin for suspected CA-MRSA

28
Q

Inpatient CAP, fully immunized, MIC ≤2: presumed atypical pneumonia

A

Azithromycin (in addition to beta-lactam if diagnosis of atypical pneumonia is in doubt)

29
Q

Azithromycin alternatives

A

clarithromycin or erythromycin; doxycycline for children >7 years old; levofloxacin for children who have reached growth maturity or can’t tolerate macrolides

30
Q

Inpatient CAP, fully immunized, MIC ≤2: presumed influenza pneumonia

A

oseltamivir or zanamivir for children ≥7 years old

31
Q

Inpatient CAP: not fully immunized, MIC ≥2: presumed bacterial pneumonia

A

Ceftriaxone 50mg/kg/dose q24h, or cefotaxime; adding vanco or clindamycin for suspected CA-MRSA

32
Q

CTX ADEs

A

diarrhea, rash, eosinophilia, pain at injection site with IM formulation

33
Q

Reason CTX is used in un-immunized children

A

Concern for H. influenzae beta-lactamase producing

34
Q

Alternatives to CTX/cefotaxime

A

levofloxacin, add vanco or clindamycin

35
Q

Inpatient CAP: not fully immunized, MIC ≥2: presumed atypical pneumonia

A

Same treatment as fully immunized

Azithromycin

36
Q

Inpatient CAP: not fully immunized, MIC ≥2: presumed influenza pneumonia

A

same as fully immunized

37
Q

CAP treatment: what to do with a non-serious allergy

A

Trial under medical supervision
Use of cephalosporins: cefpodoxime, cefprozil, cefuroxime

38
Q

CAP treatment: anaphylactic allergy

A

Respiratory fluoroquinolone
Linezolid
Macrolide
Clindamycin
Bactrim

39
Q

Duration of CAP treatment

A

10 days total of treatment, but CA-MRSA may require more

5 days only for azithromycin and oseltamivir

40
Q

When to discharge a patient with CAP

A

Clinical improvement, increased O2 sat, baseline mental status, can take PO meds

41
Q

CAP: vaccine prevention

A

PCV13, Hib, DTaP, influenza, RSV in high-risk infants

42
Q

Hallmark signs and symptoms of CAP

A

Fever, cough

43
Q

Other signs/symptoms of CAP

A

Pleuritic chest pain d/t inflammation
Purulent expectorant
Tachypnea for age (Infants: >70 breaths/min, children: >50 breaths/min)
Respiratory distress- severe CAP, severity increases as disease progresses
Retractions (suprasternal, intercostal, subcostal)
Grunting
Nasal flaring
Apnea
Wheezing
Crackles/rales
Pulse ox <90% on room air
Altered mental status

44
Q

Gold standard for diagnosing CAP

A

chest x-ray

45
Q

How to distinguish viral vs. bacterial pneumonia

A

Viral on a chest-x-ray is general haziness
Bacterial on a chest x-ray is consolidated in a specific area

46
Q

Who should be hospitalized for CAP?

A

Moderate-severe CAP
Significant respiratory distress: SPO2 <90%
All infants <3 months
Infants <6 months with suspected bacterial CAP
Suspicion/documentation of community-acquired MRSA infections
Concern for caretaker capabilities

PHM 704- Pediatrics (17 decks)

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