Pneumonia

Question 1

What reduced pneumonia admission rates in kids

Answer 1

Pneumococcal conjugate vaccines

Question 2

Most common cause of pneumonia in infants/preschool children?

Answer 2

Viruses (RSV, flu, paraflu, HMPV)

*In older kids - viruses are less commonly the only cause of pneumonia (except flu)

Question 3

Most common bacterial cause of pneumonia?

Answer 3

*Strep pneumo
GAS - much less common
S aureus - not common but increasing d/t MRSA in some places

Hib - almost disappeared

Mycoplasma & chalmydophila - common in school-aged kids

Question 4

Features of mycoplasma pneumonia?

Answer 4

Malaise, headache 7-10d then fever, cough

Question 5

Physical signs of pneumonia?

Answer 5

Reduced normal breath sounds, increased bronchial breath sounds, increased tactile fremitus/dullness to percussion

Question 6

Criteria for tachypnea in:

- 5 years

Answer 6

• 5 years: 30

Question 7

CXR should be done to dx pneumonia in:

Answer 7

All hospitalized kids (don’t need CXR as outpatient if presentation convincing)

Question 8

Atypical pathogens produce what picture on XR?

Answer 8

Bilateral focal or interstitial infiltrates (more extensive than symptoms)

Question 9

Indications for culture/drainage of pleural effusion?

Answer 9

Large effusion, insufficient response to medical therapy, r

Question 10

Indications of viral testing?

Indications of NP mycoplasma/chlam testing?

Answer 10

If admitted during flu season - antivirals can be of benefit for influenza pneumonia

Test for atypical if admitted (but positive could mean remove info)

Question 11

Indications for bloodwork and what to send?

Answer 11

CBC+diff, blood culture before starting abx in hospitalized kids

Blood cx volumes:
1-2 mL (infants)
4-5 mL (kids

Question 12

When and why to treat with antivirals?

Answer 12

Flu detected or clinically suspected for admitted or moderate-severely unwell pts

May prevent secondary bacterial infections

Question 13

First line abx for community acquired pneumonia?

Answer 13

Amoxicillin - outpt
Ampicillin - inpt

**main goal is gd coverage for S pneumo

Question 14

If resp failure/septic shock assoc with pneumonia, what abx?

Answer 14

Ceftriaxone or cefotaxime

• For pen-resistant S pneumo, beta-lactamase producing H flu, covers MSSA
• Same for empyema - MSSA, GAS more common + S pneumo
• Add vancomycin if severe illness with multi lobar disease, pneumatoceles (MRSA)

Question 15

Tx of atypical pneumonia?

Answer 15

Most resolve without abx

Quicker recovery in pts with persistent cough, more unwell

Azithro x 5 days

(macrolide resistance sometimes - if >8 years, doxycycline!)

Question 16

Duration of tx for uncomplicated pneumonia?

Answer 16

7-10d hospitalized

5d ok for outpatient

Question 17

For pen-allergic patients, what to Rx first-line?

Answer 17

Very low cross-reactivity rate - can give cefuroxime, ceftriaxone, cefprozil

(if type I rxn to pen - monitor following first dose cephalosporin)

Alternative - clarithro or azithro (but increasing S pneumo resistance)

Question 18

Timing of clinical response to abx?

Answer 18

Usually improves within 48h

XR findings clear in 4-6 weeks