Pediatrics - Bacterial Meningitis & Community-Acquired Pneumonia Flashcards
What are the most common offenders for bacterial meningitis in those <1 month of age? (4)
Groub B Streptococcus, E. coli, Listeria monocytogenes, Klebsellia species
What are the most common offenders for bacterial meningitis in those 1-23 months of age? (4)
S. pneumoniae, Neisseria meningitidis, H. influenzae (Type B), E. coli
What are the most common offenders for bacterial meningitis in those 2-50 years of age? (2)
N. meningitidis, S. pneumoniae
What are neonate risk factors for bacterial meningitis?
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
What are children risk factors for bacterial meningitis?
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
How do infants present with bacterial meningitis?
poor feeding, vomiting, fever/temperature, seizures, irritability, lethargy, bulging fontanelle
How do children present with bacterial meningitis?
fever, HA, lethargy, vomiting, myalgia, photophobia, stiff neck, seizure, confusion
What are CIs for lumbar puncture?
increased intracranial pressure, coagulopathy, hemodynamic/respiratory instability, skin infection over site
What is treatment for bacterial meningitis in <1 month of age? (2)
ampicillin + AG, or ampicillin + cefotaxime
What can be added if HSV is suspected in bacterial meningitis?
acyclovir
What is treatment for bacterial meningitis in 1-23 months of age?
vancomycin + cefotaxime/ceftriaxone
What is treatment for bacterial meningitis in 2-50 years of age?
vancomycin + cefotaxime/ceftriaxone
What are AEs for ampicillin? (4)
diarrhea, nausea, vomiting, rash
What are AEs for cefotaxime? (5)
diarrhea, nausea, vomiting, rash, pruritis
What is important regarding ceftriaxone?
do not use in neonates due to risk of hyperbilirubinemia
What are AEs for vancomycin?
nephrotoxicity, ototoxicity, infusion related reactions
What may dexamethasone adjunctive therapy help prevent in meningitis? When does it not help?
hearing loss in infants and children (NOT NEONATES) infected with H. influenzae
What is the dosing for dexamethasone in meningitis?
0.15 mg/kg/dose IV q6h for 2-4 days
What are the ISDA recommendations for dexamethasone in the types of meningitis infections? (3)
H. influenzae = recommended if initiated before administration of antibiotics; S. pneumoniae = consider if high mortality risk; N. meningitidis = NOT recommended
What is another name for hospital-acquired?
nosocomial
What are risk factors for community-acquired pneumonia?
recent URTI, lower SE status, crowded living environment, secondhand smoke, comorbidities (asthma, bronchopulmonary dysplasia, CF, sickle cell disease, congenital heart disease)
What are the routes pathogens can enter the lungs? (3)
inhaled aerosolized particles (most common), through the bloodstream, aspiration
What are signs/symptoms of community-acquired pneumonia in pediatrics?
fever, cough, pleuritic chest pain, purulent expectorant, tachypnea, respiratory distress, AMS
How can one tell viral versus bacterial pneumonia on an x-ray visually?
hazy = viral; dense consolidations = bacterial
What is the gold standard for diagnosing community-acquired pneumonia?
chest x-ray
Who should be hospitalized for community-acquired pneumonia? (6)
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
What is the most common pathogen for community-acquired pneumonia across all age groups?
streptococcus pneumoniae
What age group are atypical bacteria more common in?
older children
What viruses are most common in community-acquired pneumonia?
influenza virus, RSV, PIV, adenovirus, rhinovirus
What is the best predictor of cause via identification of likely pathogen and exposure?
age
When should symptom resolution occur after treatment of CAP?
within 48-72 hrs
What is first-line treatment for presumed bacterial pneumonia in outpatient CAP in <5 yo?
amoxicillin 90 mg/kg/day in 2 doses
What is alternative treatment for presumed bacterial oupatient CAP in <5 yo?
amoxicillin clavulanate 90 mg/kg/day in 2 doses
What is first-line treatment for presumed atypical pneumonia in outpatient CAP in 5 or more yo?
azithromycin 10 mg/kg/day (day 1) then 5 mg/kg/day (days 2-5)
What is first-line treatment for presumed bacterial pneumonia in inpatient CAP if fully immunized? (2)
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
What is first-line treatment for presumed bacterial pneumonia in inpatient CAP if not fully immunized?
ceftriaxone 50 mg/kg/dose IV q24hr
When is antiviral therapy (oseltamivir) effective in CAP?
if initiated within 48 hours of symptoms
What is the duration of therapy for antibiotics in CAP?
10 days
Which antibiotics need only 5 days of treatment? (2)
azithromycin and oseltamivir
What are alternatives to a non-serious allergic reaction? (3)
cephalosporins (cefpodoxime, cefprozil, cefuroxime)
What are alternatives to a serious allergic reaction? (5)
levofloxacin, linezolid, macrolides, clindamycin, sulfamethoxazole-trimethoprim
