CPG 2021 PCAP Flashcards
PCAP is considered in a patient who presents with FEVER and COUGH, plus
> Tachypnea 3 mos - 12 mos: >50 bpm >1 yo - 5 yo: >40 bpm >5 yo - 12 yo: >30 bpm >12 yo: >20 bpm > retractions or chest indrawing > Nasal flaring > 02 sat <95% at room air > grunting
What clinical and ancillary parameters will determine the need for admission
- indication for admission: 1 parameter, clinical and or imaging
- predictor of high-risk for pneumonia mortality: 1 clinical or ancillary parameter should be present; absence of ancillary parameter, a clinical parameter will suffice
Basis for return to the facility for admission
> Signs of deterioration: hypoxemia, chest indrawing/retractions, grunting, altered sensorium, pallor withing 48 hrs
refuses or unable to feed, drink or take medications
has an underlying medical condition
absence of caregiver, inability for close follow-up, no easily accessible medical facility
What diagnostic aids will confirm the presence of non-severe CAP in an ambulatory setting?
Routine diagnostic aids are not considered
What diagnostic aids will confirm the presence of severe CAP in hospital setting?
Chest x-ray
Point-of-care chest ultrasonography (POCUS)
Procalcitonin
Sputum gram stain and culture - not routinely done
CBC, ABG, serum electrolytes
What clinical and ancilliary parameters will determine the need for antibiotic treatment?
Elevated WBC
elevated CRP
evelated procalcitonin
Imaging findings:
alveolar infiltrates in radiograph;
unilateral, solitary lung consolidation and or air bronchograms and or pleural effusion on
lung ultrasound
For non-severe PCAP, regardless of immunization status against S. pneumoniae and H. influenzae type b what empiric treatment is effective?
> Amoxicillin trihydrate 40-40mkD q 8h for 7 days or 80-90 mkD q 12h for 5-7 days
Amoxicillin-clavulanate 80-90mkD q12 for 5-7 days
cefuroxime 20-30 mkD q12h for 7 days in settings with documented high level penicillin
resistant pneumococci or beta-lactamase producing H. Influenzae
For severe PCAP, regardless of immunization status against S. pneumoniae what empiric treatment is effective?
> start Penicillin G 200,000 ukD q 6h - complete Hib vaccination
Start Ampicillin 200 mkD q6h - no or incomplete Hib vaccination
> in documented high level penicillin resistant pneumococci or beta-lactamase producing H. Influenzae, start
Cefuroxime 100-150 mkD q 8h
Ceftriaxone 75-100 mkD q12 to q24h
Ampicillin-sulbactam 200mkD q6h
> suspected Staphylococcal pneumonia
Add clindamycin 20-40 mkD q6-8h
Severe and life threatening vancomycin 40-60 mkD q6 to q8h
For patients with know hypersensitivity to penicillin?
> Non-type 1 hypersensitivity
cefuroxime po 20-30 mkD q 12 or IV 100-150 mkD q8h
Ceftriaxone 75-100 mkD q12-24
> type 1 hypersensitivity (immediate, anaphylactic type)
Azithromycin 10 mkD PO or IV q24h for 3-5 days OR 10 mkD on day 1 ff by 5 mkD q 24 for days 2-5
Clarithromycin 15 mkD q 12 for 7 days
Clindamycin 10-40 mkD PO OR 20-40 mkD IV q 6 to 8h for 7 days
When atypical pathogen is highly suspected, start a macrolide as follows
Azithromycin 10 mkD PO or IV q24h for 5 days particularly in infants <6 mos old,who, pertussis is entertained OR 10 mkD on day 1 ff by 5 mkD q 24 for days 2-5
Clarithromycin 15 mkD q 12 for 7 days
How many days when treating uncomplicated bacterial PCAP?
7-10 days is considered but longer duration may be required depending on pts clinical response, virulence of organism and complications
Will the addition of a macrolide to standard empiric regimen improve treatment outcome?
No
What treatment is effective if a viral etiology is considered
Oseltamivir started immediately within 36 hrs of laboratory confirmed influenza infection
- givn BID for 5 days
- < 1 yo: 3mkd
- > 1 yo and older: based on weight
15 or less - 30 mg
> 15-23 kg - 45 mg
>23-40 kg - 60 mg
<40 kg - 75 mgbFor patients with non-severe PCAP, what clinical and ancillary parameters will determine a good response to current therapeutic management?
- Improvement in cough
- normalization of core body temperature in celsius in the absence of antipyretics within 24-72 hours after initiation of treatment
For patients with severe PCAP, what clinical and ancillary parameters will determine a good response to current therapeutic management?
Any one observed within 24-72 hours after initiatiom of treatment:
- Absence or Resolution of hypoxia (02 sat <95% at room air)
- Absence or Resolution of danger signs ( nasal flaring, gruntinh, head bobbing, cyanosis)
- Absence or Resolution of tachypnea
- Absence or Resolution of fever
- Absence or Resolution of tachycardia
- Resolving or Improving radiologic pneumonia
- Resolving or Absent chest ultrasound findings (fluid bronchogram, multifocal involvement, and pleural effusion)
- Normal or Decreasing CRP
- Normal or Decreasing PCT
