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PCAP Flashcards

1
Q

What is the key recommendation regarding the addition of a macrolide to standard beta-lactam antibiotic therapy for bacterial community-acquired pneumonia (PCAP)?

A

The addition of a macrolide is not considered in the empiric treatment of bacterial PCAP (Conditional recommendation, very low-grade evidence).

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2
Q

What is the strong recommendation for the treatment of viral pneumonia in children?

A

Oseltamivir is strongly recommended to be started immediately within 36 hours of laboratory-confirmed influenza infection (Strong recommendation, high-grade evidence).

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3
Q

What is the recommended timing for administering oseltamivir for maximum benefit?

A

Oseltamivir should be administered within 48 hours of symptom onset for maximum benefit.

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4
Q

What clinical indicators signify a good response to therapeutic management in non-severe PCAP?

A

Good response is indicated by sustained clinical stability for 24 hours with improvement of cough or normalization of core body temperature.

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5
Q

For severe PCAP, what parameters are observed to determine a good response to treatment?

A

Parameters include absence of hypoxia, danger signs, tachypnea, fever, tachycardia, and improving radiologic pneumonia.

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6
Q

What is defined as hypoxia in children?

A

Hypoxia is defined as having peripheral O2 saturation less than 95% at room air.

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7
Q

What are some danger signs in pediatric pneumonia?

A

Danger signs include nasal flaring, grunting, head bobbing, and cyanosis.

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8
Q

What is the recommended dosage of oseltamivir for children younger than 1 year old?

A

3 mg/kg/dose twice a day for 5 days.

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9
Q

True or False: The immunization status for influenza should influence the decision to initiate treatment with oseltamivir.

A

False.

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10
Q

What is the definition of absolute clinical stability in pneumonia management?

A

Resolution of ALL pneumonia-associated signs and symptoms AND recovery to pre-pneumonia health status.

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11
Q

What is the definition of approaching clinical stability in pneumonia management?

A

Resolution of ANY pneumonia-associated sign or symptom OR delayed recovery to pre-pneumonia health status.

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12
Q

What is the significance of repeat chest X-ray in pneumonia management?

A

Not routinely done as long as there is clinical improvement evidenced by physiologic parameters.

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13
Q

What are the key diagnostic evaluations for non-severe PCAP not improving after 24-72 hours?

A
  • Coexisting or other etiologic agents
  • Etiologic agent resistant to current antibiotic
  • Other diagnosis
  • Pneumonia-related complication
  • Pleural effusion
  • Necrotizing pneumonia
  • Lung abscess
  • Asthma
  • Pulmonary tuberculosis
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14
Q

What should be done for patients with non-severe PCAP who are not improving after 24-72 hours?

A

Consider increasing the dose of Amoxicillin or switching to Amoxicillin-Clavulanate or Cefuroxime.

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15
Q

What is the recommended action for severe PCAP patients not improving after 24-72 hours?

A

Diagnostic evaluation to determine potential complications or resistance.

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16
Q

What are the clinical parameters for considering switch therapy in severe bacterial PCAP?

A
  • Current parenteral antibiotic given for at least 24 hours
  • Afebrile for at least 8 hours without antipyretics
  • Able to feed without vomiting or diarrhea
  • Clinical improvement defined by absence of hypoxia, danger signs, tachypnea, fever, tachycardia.
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17
Q

What is the importance of the study by In-iw et al. (2015) regarding switch therapy?

A

Showed statistically significant reduction in length of hospital stay for switch therapy group.

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18
Q

What is the significance of biomarkers in pneumonia management?

A

Used for diagnostic evaluations in cases of treatment failure.

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19
Q

True or False: Blood cultures are routinely performed in pediatric patients with non-severe pneumonia.

A

False.

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20
Q

Fill in the blank: The presence of _______ is a conditional recommendation for patients with severe PCAP who are not improving.

A

coexisting or other etiologic agents.

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21
Q

What is the recommended action for patients with severe PCAP suspected of septicemia?

A

Consider blood culture and sensitivity.

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22
Q

What are the potential complications to evaluate in severe PCAP treatment failure?

A
  • Pneumothorax
  • Necrotizing pneumonia
  • Lung abscess
  • Asthma
  • Pulmonary tuberculosis
  • Sepsis.
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23
Q

What is the average time for normalization of fever in patients aged <2 years with pneumonia?

A

14.5 hours (4.5-45.3 CI).

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24
Q

What is the recommendation for adding a macrolide in pneumonia treatment?

A

Considered when an atypical pathogen is highly suspected.

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25
What is the significance of clinical improvement in pneumonia management?
Indicates readiness for switch therapy and potential discharge.
26
What is one benefit of switch therapy in hospitalized patients?
Reduced length of hospital stay ## Footnote This can lead to lesser risk of infections from infected IV lines and hospital pathogens.
27
What did the observational study by Sharma et al. find regarding switch therapy?
Lower number of complications but no difference in treatment outcome compared to standard treatment group.
28
What should follow restricted and monitored antibiotics in switch therapy?
DOH-Antimicrobial Stewardship Manual of Procedures.
29
What is strongly recommended as adjunctive treatment for measles pneumonia?
Vitamin A (strong recommendation, high-grade evidence).
30
Is zinc recommended as adjunctive treatment for severe PCAP?
No, it does not shorten recovery time (conditional recommendation, low-grade evidence).
31
Is Vitamin D considered effective for severe PCAP?
No, it does not reduce length of hospital stay (conditional recommendation, low-grade evidence).
32
Under what condition are bronchodilators considered for PCAP?
In the presence of wheezing (conditional recommendation, expert opinion).
33
Which agents are not considered as adjunctive treatment for PCAP?
Mucokinetic, secretolytic, and mucolytic agents.
34
What is the evidence level for oral folate as adjunctive treatment for PCAP?
Very low-grade evidence.
35
What does the evidence suggest about adjunctive zinc treatment in children with pneumonia in LMICs?
No evidence that it improves recovery.
36
What is a key recommendation for preventing PCAP in children aged 3 months to 3 years?
Vaccination against Streptococcus pneumoniae, Hib, Bordetella pertussis, Rubeola virus, and Influenza virus.
37
What is the impact of breastfeeding on pneumonia incidence in young children?
Decreases incidence by up to 32%.
38
What should be avoided to prevent PCAP according to the recommendations?
Environmental tobacco smoke or indoor biomass fuel exposure.
39
What is the effect of zinc supplementation on pneumonia incidence?
Reduces incidence by 13% (moderate-grade evidence).
40
What does the evidence say about vitamin C supplementation for pneumonia?
Very low quality of evidence; uncertain effect.
41
What is the recommended dosage of Vitamin A for children diagnosed with measles?
100,000 IU for infants under 12 months, 200,000 IU for older children.
42
What is the recommendation regarding the use of OTC medications for cough in pneumonia?
Insufficient evidence to decide if they are beneficial.
43
What is the risk factor for pneumonia morbidity and mortality associated with cooking practices?
Carrying children on caregivers’ backs while cooking.
44
What is the recommendation for hydration and oxygenation in pediatric community-acquired pneumonia?
Must be administered as part of standard care.
45
What is the effect of vitamin C supplementation on pneumonia prevention and treatment?
Uncertain due to very low quality of evidence from a limited number of studies. ## Footnote Padhani et al. (2020) conducted a systematic review that included 5 RCTs and 2 quasi-RCTs.
46
What were the findings regarding vitamin D supplementation for pneumonia?
No significant difference in pneumonia episodes between supplemented and un-supplemented groups. ## Footnote MY et al. (2016) reported a rate ratio of 1.06 for 'radiologically confirmed' pneumonia.
47
What is the GRADE level of evidence for vitamin C and D supplementation in pneumonia prevention?
Very Low. ## Footnote This indicates a lack of robust evidence supporting their effectiveness.
48
What role does vaccination play in preventing pneumonia?
Vaccination against Hib, pneumococcus, measles, and pertussis can prevent pneumonia. ## Footnote WHO recommends PCVs in childhood immunization programs.
49
How does breastfeeding impact pneumonia incidence in young children?
Breastfeeding decreases pneumonia incidence by up to 32%. ## Footnote Shorter breastfeeding duration is linked to higher pneumonia mortality.
50
What is the association between environmental tobacco smoke and pneumonia?
ETS exposure increases the risk of pneumonia and severe disease in children. ## Footnote A systematic review showed significant odds ratios for LRTI associated with parental smoking.
51
What is the importance of zinc in pneumonia prevention?
Zinc is essential for immunity and can prevent pneumonia in children aged 2 to 59 months. ## Footnote Daily supplementation with 10mg of Zinc for 4 to 6 months improves immune response.
52
What strategies can reduce the burden of pediatric pneumonia?
Vaccination, breastfeeding, avoidance of tobacco smoke, and zinc supplementation. ## Footnote These strategies have led to a reduction in disease burden and mortality.
53
What is the impact of maternal smoking on infant respiratory health?
Antenatal or early-life ETS exposure increases susceptibility to respiratory diseases. ## Footnote ETS exposure is reported as a significant risk factor for childhood LRTI.
54
What imaging modality is preferred for assessing pediatric community-acquired pneumonia?
Chest radiography is the initial imaging modality of choice. ## Footnote Follow-up frequency depends on the patient's clinical status.
55
What role does chest CT play in pneumonia complications?
CT scans are used for complications like bronchopleural fistula or lung abscess. ## Footnote IV contrast is used for specific conditions as indicated.
56
True or False: The Technical Working Group found robust evidence for vitamin A, C, or D supplementation in preventing pneumonia.
False. ## Footnote No robust evidence was found for these vitamins in pneumonia prevention.
57
What should future research focus on regarding pediatric community-acquired pneumonia?
Identify clinical features, evaluate scoring systems, and assess the effectiveness of interventions. ## Footnote Emphasis on well-designed clinical trials is recommended.
58
Fill in the blank: The 23-valent pneumococcal polysaccharide vaccine is not routinely recommended for __________.
immunocompetent children. ## Footnote It is given only to at-risk children over 2 years old.
59
What is the significance of the findings from the study by Lamberti et al. regarding breastfeeding?
Breastfeeding reduces pneumonia morbidity and mortality in children under two. ## Footnote This finding is supported by systematic literature reviews.
60
What imaging tool is appropriate for pneumonia complicated by suspected bronchopleural fistula or lung abscess seen on radiograph?
CT scan with IV contrast ## Footnote CT scan is crucial for evaluating complications in pneumonia cases.
61
When is a CT scan without IV contrast appropriate?
For non-localized recurrent pneumonia seen on the radiograph ## Footnote This helps identify cases without specific localized findings.
62
What imaging tool is appropriate for localized recurrent pneumonia seen on the radiograph?
CT scan with IV contrast or CT angiography ## Footnote These modalities provide detailed vascular imaging for localized issues.
63
In what scenario is ultrasound usually appropriate for pneumonia?
In immunocompetent children with pneumonia complicated by moderate or large effusion seen on chest radiograph ## Footnote Ultrasound is a non-invasive method for assessing pleural effusions.
64
What is a positive predictor of radiographic pneumonia in children aged 3 months to 5 years?
Oxygen saturation less than or equal to 94% at room air ## Footnote This threshold indicates possible respiratory distress.
65
What clinical sign may indicate pneumonia if present in a patient aged 3 months to 5 years?
Tachypnea ## Footnote Defined as increased respiratory rate based on WHO criteria.
66
List some signs that indicate pneumonia at any age.
* Fever * Grunting * Wheezing * Decreased breath sounds * Nasal flaring * Cyanosis * Crackles * Localized chest findings ## Footnote These signs are critical for assessing pneumonia severity.
67
What negative predictor might suggest pneumonia is not present?
Oxygen saturation greater than 94% at room air ## Footnote This indicates adequate oxygenation and may rule out pneumonia.
68
When should a chest x-ray be requested?
In cases of dehydration in a patient aged 3 months to 5 years or with a high index of clinical suspicion ## Footnote Chest x-rays are vital for visualizing pneumonia.
69
What are the four classifications of pCAP based on risk of pneumonia-related mortality?
* pCAP A * pCAP B * pCAP C * pCAP D ## Footnote These classifications help determine treatment intensity and care level.
70
What respiratory signs are present in pCAP A?
None ## Footnote pCAP A indicates non-severe pneumonia.
71
What is a common circulatory sign in pCAP B?
Capillary refill >3 seconds ## Footnote This indicates potential circulatory compromise.
72
What indicates a patient has pCAP C?
Clinical parameters indicating very severe or high risk ## Footnote Patients classified as pCAP C may require hospitalization.
73
What is a common central nervous system sign in pCAP D?
Lethargic/stuporous/comatose ## Footnote This reflects the severity of the clinical condition.
74
What ancillary parameter is significant for pCAP C and D?
Chest x-ray findings of effusion, abscess, air leak, or multi-lobar consolidation ## Footnote These findings necessitate careful management.
75
What may be included in the initial assessment of a patient with pneumonia?
* Oxygen saturation using pulse oximetry * Gram stain and/or aerobic culture and sensitivity of sputum * Chest x-ray PA-lateral * Chest ultrasound ## Footnote These tests help identify gas exchange issues and microbial etiology.
76
What diagnostic aid may be requested for assessing gas exchange?
Arterial blood gas ## Footnote This helps evaluate respiratory function and acid-base balance.
77
What may indicate treatment failure in patients classified as PCAP A or B?
Not improving or clinically worsening within 72 hours after initiating treatment ## Footnote This necessitates further diagnostic evaluation.
78
What is the recommended antibiotic for patients classified as PCAP A or B without previous antibiotic treatment?
Amoxicillin trihydrate ## Footnote Dosing varies based on local resistance patterns.
79
What is a common treatment for patients suspected of having community-acquired methicillin-resistant Staphylococcus aureus?
Vancomycin may be started ## Footnote This antibiotic is critical for resistant infections.
80
True or False: Antiviral drug therapy is beneficial for PCAP C or D with suspected non-influenza virus.
False ## Footnote Antivirals are not effective for non-influenza pathogens.
81
What may indicate good clinical response to treatment?
Achieving clinical stability that is sustained for the immediate past 24 hours ## Footnote Stability indicates effective management of pneumonia.
82
What is the significance of chest x-ray or complete blood count in therapeutic management?
Good clinical response may not require these tests to document treatment success at end of treatment.
83
What should be considered if a patient classified as PCAP A or PCAP B is not improving within 72 hours?
Diagnostic evaluation for: * Coexisting or other etiologic agents * Etiologic agent resistant to current antibiotic * Other diagnosis * Pneumonia-related complication * Necrotizing pneumonia * Pleural effusion * Asthma * Pulmonary tuberculosis
84
What diagnostic evaluations should be considered for patients under 5 years or classified as PCAP C not improving within 48 hours?
Diagnostic evaluation for: * Coexisting or other etiologic agents * Etiologic agent resistant to current antibiotic * Other diagnosis * Pneumonia-related complication * Acute respiratory failure * Pleural effusion * Pneumothorax * Necrotizing pneumonia * Lung abscess * Asthma * Pulmonary tuberculosis * Sepsis
85
What action may be taken if a patient classified as PCAP D is clinically worsening within 24 hours?
Referral to a specialist may be done.
86
What conditions must be met to switch from intravenous to oral antibiotics for PCAP C?
Conditions include: * Current parenteral antibiotic given for at least 24 hours * Afebrile in the last 8 hours without antipyretic * Responsive to current antibiotic therapy * Able to feed, without vomiting or diarrhea * No current pulmonary or extrapulmonary complications * Oxygen saturation > 95% at room air
87
What may be beneficial during the course of illness for PCAP A or PCAP B?
Beneficial treatments include: * Oral steroid in a patient with coexisting asthma * Bronchodilator in the presence of wheezing
88
What treatments may not be beneficial for PCAP A or PCAP B?
Treatments that may not be beneficial include: * Cough preparation or parenteral steroid in a patient without asthma * Elemental zinc, vitamin D3, and probiotic
89
What beneficial treatments are suggested for PCAP C?
Beneficial treatments include: * Nasal catheter or prong for oxygen administration * Zinc supplement in reducing mortality * Bubble CPAP instead of low flow oxygen * Steroid or spirulina in reducing length of stay * Oxygen for saturation below 95%
90
What treatments may not be beneficial for PCAP C?
Treatments that may not be beneficial include: * Zinc supplement in reducing treatment failure or length of stay * Vitamin D3 in reducing length of stay * Parenteral steroid, probiotic, virgin coconut oil, oral folate, nebulization using saline or acetylcysteine
91
What actions may be beneficial during the course of illness for PCAP D?
Referral to a specialist may be beneficial.
92
What are beneficial measures to reduce hospitalization due to pneumonia?
Beneficial measures include: * Conjugated vaccine against Streptococcus pneumoniae * Vaccine against Hib, Influenza sp., and Diphtheria, Pertussis, Rubeola, and Varicella * Breastfeeding * Avoidance of cigarette smoke and biomass fuel
93
What are not beneficial in reducing the impact of pneumonia?
Not beneficial measures include: * Zinc supplement * Vitamin D

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