Pneumonia (peds)
Background
- Most common site of infection in neonates
Bugs by Age Group
- Newborn
- Group B streptococci
- Gram-negative bacilli
- Listeria monocytogenes
- 1-3 months
- 3 months-5 years
- S. pneumoniae
- S. aureus
- H. influenzae type b
- Nontypeable H. influenzae
- C. trachomatis
- Mycoplasma pneumoniae
- 5–18 years
- M. pneumoniae
- S. pneumoniae
- C. pneumoniae
- H. influenzae type b
- S. aureus
Clinical Features
Fever and tachypnea are sensitive but not specific
Differential Diagnosis
Pediatric fever
Evaluation
- Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
- Imaging
- CXR is not the gold standard!
- Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
- Consider for:
- Age 0-3mo (as part of sepsis workup)
- <5yr with temperature >102.2, WBC >20K and no clear source of infection
- Ambiguous clinical findings
- Pneumonia that is prolonged or not responsive to antibiotics
- Consider rapid assays for RSV, influenza
- Blood/nasal culture are low yield
- in prospective study, 91 blood cultures needed for one positive result for CAP; but in ICU one child had bacteremia for every 24 cultures obtained, one for every 12 with parapneumonic effusion [1]
- consider for sicker ones, those with effusions
Treatment[2]
Newborn
- Hospitalized
- Ampicillin (80-90mg/kg/day) + gentamicin +/- cefotaxime
- Add vancomycin if MRSA a concern
- Add erythromycin (12.g mg/kg QID) if concern for chlamydia
- Ampicillin (80-90mg/kg/day) + gentamicin +/- cefotaxime
- Outpatient
- Initial outpatient management not recommended
1-3 Month
- Hospitalized
- Afebrile pneumonitis
- Erythromycin (10 mg/kg q6) or azithro (2.5 mg/kg q12)
- Febrile pneumonia
- Add cefoTAXime (200mg/kg per day divided q8h)
- Afebrile pneumonitis
- Outpatient
- erythromycin OR azithro PO
>3mo - 18 years
- Hospitalized (PICU/severely ill)
- Ceftriaxone IV AND vancomycin AND consider azithromycin
- Hospitalized (moderately ill)
- Fully immunized: Ampicillin (50mg/kg q6) IV
- Not fully immunized: Ceftriaxone IV
- Outpatient
- Amoxicillin (90 mg/kg divided BID) x 5 days PO
- Alternative: clindamycin OR azithromycin OR amoxicillin-clavulanate
Disposition
All Children less than 2 months should be hospitalized[3]
Consider Admission For
- Age: <2-3 months old
- History of severe or relevant congenital disorders
- Immune suppression (HIV, SCD, malignancy)
- Toxic appearance/respiratory distress
- SpO2 <90-93%
- Vomiting/dehydration
- Unstable social environment
See Also
- Pneumonia (Main)
- Pediatric fever
References
- Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics. 2019 Jun 19.
- Sanford Guide to Antimicrobial Therapy 2014
- AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011
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