Pediatrics - Bacterial Meningitis & Community-Acquired Pneumonia

Question 1

What are the most common offenders for bacterial meningitis in those <1 month of age? (4)

Answer 1

Groub B Streptococcus, E. coli, Listeria monocytogenes, Klebsellia species

Question 2

What are the most common offenders for bacterial meningitis in those 1-23 months of age? (4)

Answer 2

S. pneumoniae, Neisseria meningitidis, H. influenzae (Type B), E. coli

Question 3

What are the most common offenders for bacterial meningitis in those 2-50 years of age? (2)

Answer 3

N. meningitidis, S. pneumoniae

Question 4

What are neonate risk factors for bacterial meningitis?

Answer 4

preterm birth, low birthweight (<2500 g), chorioamnionitis, maternal endometritis or GBS colonization, prolonged intrauterine monitoring (>12 hrs) or rupture of membranes, traumatic delivery, urinary tract abnormalities

Question 5

What are children risk factors for bacterial meningitis?

Answer 5

asplenia, primary immunodeficiency, HIV, sickle cell anemia, cochlear implant, CSF leak, recent URTI, daycare attendance, exposure to bacterias that cause, penetrating head trauma, lack of immunizations

Question 6

How do infants present with bacterial meningitis?

Answer 6

poor feeding, vomiting, fever/temperature, seizures, irritability, lethargy, bulging fontanelle

Question 7

How do children present with bacterial meningitis?

Answer 7

fever, HA, lethargy, vomiting, myalgia, photophobia, stiff neck, seizure, confusion

Question 8

What are CIs for lumbar puncture?

Answer 8

increased intracranial pressure, coagulopathy, hemodynamic/respiratory instability, skin infection over site

Question 9

What is treatment for bacterial meningitis in <1 month of age? (2)

Answer 9

ampicillin + AG, or ampicillin + cefotaxime

Question 10

What can be added if HSV is suspected in bacterial meningitis?

Answer 10

acyclovir

Question 11

What is treatment for bacterial meningitis in 1-23 months of age?

Answer 11

vancomycin + cefotaxime/ceftriaxone

Question 12

What is treatment for bacterial meningitis in 2-50 years of age?

Answer 12

vancomycin + cefotaxime/ceftriaxone

Question 13

What are AEs for ampicillin? (4)

Answer 13

diarrhea, nausea, vomiting, rash

Question 14

What are AEs for cefotaxime? (5)

Answer 14

diarrhea, nausea, vomiting, rash, pruritis

Question 15

What is important regarding ceftriaxone?

Answer 15

do not use in neonates due to risk of hyperbilirubinemia

Question 16

What are AEs for vancomycin?

Answer 16

nephrotoxicity, ototoxicity, infusion related reactions

Question 17

What may dexamethasone adjunctive therapy help prevent in meningitis? When does it not help?

Answer 17

hearing loss in infants and children (NOT NEONATES) infected with H. influenzae

Question 18

What is the dosing for dexamethasone in meningitis?

Answer 18

0.15 mg/kg/dose IV q6h for 2-4 days

Question 19

What are the ISDA recommendations for dexamethasone in the types of meningitis infections? (3)

Answer 19

H. influenzae = recommended if initiated before administration of antibiotics; S. pneumoniae = consider if high mortality risk; N. meningitidis = NOT recommended

Question 20

What is another name for hospital-acquired?

Answer 20

nosocomial

Question 21

What are risk factors for community-acquired pneumonia?

Answer 21

recent URTI, lower SE status, crowded living environment, secondhand smoke, comorbidities (asthma, bronchopulmonary dysplasia, CF, sickle cell disease, congenital heart disease)

Question 22

What are the routes pathogens can enter the lungs? (3)

Answer 22

inhaled aerosolized particles (most common), through the bloodstream, aspiration

Question 23

What are signs/symptoms of community-acquired pneumonia in pediatrics?

Answer 23

fever, cough, pleuritic chest pain, purulent expectorant, tachypnea, respiratory distress, AMS

Question 24

How can one tell viral versus bacterial pneumonia on an x-ray visually?

Answer 24

hazy = viral; dense consolidations = bacterial

Question 25

What is the gold standard for diagnosing community-acquired pneumonia?

Answer 25

chest x-ray

Question 26

Who should be hospitalized for community-acquired pneumonia? (6)

Answer 26

moderate-to-severe, sPO2 < 90%, all infants < 3 months of age or infants < 6 months with suspected bacterial CAP, documentation of MRSA, concern for caretaker capabilities, underlying medical conditions

Question 27

What is the most common pathogen for community-acquired pneumonia across all age groups?

Answer 27

streptococcus pneumoniae

Question 28

What age group are atypical bacteria more common in?

Answer 28

older children

Question 29

What viruses are most common in community-acquired pneumonia?

Answer 29

influenza virus, RSV, PIV, adenovirus, rhinovirus

Question 30

What is the best predictor of cause via identification of likely pathogen and exposure?

Answer 30

age

Question 31

When should symptom resolution occur after treatment of CAP?

Answer 31

within 48-72 hrs

Question 32

What is first-line treatment for presumed bacterial pneumonia in outpatient CAP in <5 yo?

Answer 32

amoxicillin 90 mg/kg/day in 2 doses

Question 33

What is alternative treatment for presumed bacterial oupatient CAP in <5 yo?

Answer 33

amoxicillin clavulanate 90 mg/kg/day in 2 doses

Question 34

What is first-line treatment for presumed atypical pneumonia in outpatient CAP in 5 or more yo?

Answer 34

azithromycin 10 mg/kg/day (day 1) then 5 mg/kg/day (days 2-5)

Question 35

What is first-line treatment for presumed bacterial pneumonia in inpatient CAP if fully immunized? (2)

Answer 35

ampicillin or penicillin G; S. pneumoniae = 150-200 mg/kg/day IV divided q6hr, MIC 4 or more = 300-400 mg/kg/day IV divided q6hr

Question 36

What is first-line treatment for presumed bacterial pneumonia in inpatient CAP if not fully immunized?

Answer 36

ceftriaxone 50 mg/kg/dose IV q24hr

Question 37

When is antiviral therapy (oseltamivir) effective in CAP?

Answer 37

if initiated within 48 hours of symptoms

Question 38

What is the duration of therapy for antibiotics in CAP?

Answer 38

10 days

Question 39

Which antibiotics need only 5 days of treatment? (2)

Answer 39

azithromycin and oseltamivir

Question 40

What are alternatives to a non-serious allergic reaction? (3)

Answer 40

cephalosporins (cefpodoxime, cefprozil, cefuroxime)

Question 41

What are alternatives to a serious allergic reaction? (5)

Answer 41

levofloxacin, linezolid, macrolides, clindamycin, sulfamethoxazole-trimethoprim