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Pneumonia Management in Children

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  1. See Also
    1. Pneumonia
    2. Pneumonia in Children
    3. Pneumonia Causes in Children
  2. Management: General
    1. See Pneumonia Management
    2. See age directed management below
    3. Indications for hospitalization
      1. All infants under age 4 months
      2. Toxic appearance
      3. Hypoxemia (Oxygen Saturation <92% or cyanosis)
      4. Respiratory distress (Apnea, grunting, nasal flaring)
      5. Dehydration with Vomiting or poor oral intake
      6. Immunocompromised patient
      7. Pneumonia refractory to oral antibiotics
      8. Unreliable home environment
      9. (2002) Thorax 57:i1
  3. Management: Newborn (under 3 weeks old)
    1. Admit all newborns with Pneumonia
    2. Antibiotic regimen (Use 2-3 antibiotics combined)
      1. Antibiotic 1: Ampicillin
        1. Age <7 days
          1. Weight <2 kg: 50-100 mg/kg divided q12 hours
          2. Weight >2 kg: 75-150 mg/kg divided q8 hours
        2. Age >7 days
          1. Weight <1.2 kg: 50-100 mg/kg divided q12 hours
          2. Weight 1.2-2 kg: 75-150 mg/kg divided q8 hours
          3. Weight >2 kg: 100-200 mg/kg divided q6 hours
      2. Antibiotic 2: Gentamicin (dosing below if >37 weeks)
        1. Age <7 days: 2.5 mg/kg repeated q12 hours
        2. Age >7 days: 2.5 mg/kg repeated q8 hours
      3. Antibiotic 3: Cefotaxime (optional)
        1. Age <7 days: 100 mg/kg divided q12 hours
        2. Age >7 days: 150 mg/kg divided q8 hours
    3. Organisms requiring additional antibiotic coverage
      1. Methicillin Resistant Staphylococcus Aureus (MRSA)
        1. Vancomycin
      2. Chlamydia trachomatis
        1. Erythromycin
  4. Management: Age 3 weeks to 3 months
    1. Outpatient (if affebrile without respiratory distress)
      1. Azithromycin 10 mg/kg day 1, 5 mg/kg days 2-5 or
      2. Erythromycin 30-40 mg/kg/day PO divided q6 hours x10d
    2. Inpatient (if febrile or hypoxic)
      1. Erythromycin 40 mg/kg/day IV divided q6 hours and
      2. One of the following antibiotics if febrile
        1. Cefotaxime 200 mg/kg/day IV divided q8 hours or
        2. Cefuroxime 150 mg/kg/day IV divided q8 hours
    3. Critically ill
      1. Cefotaxime as above and Cloxacillin or
      2. Cefuroxime alone as above
  5. Management: Age 3 months to 5 years
    1. Outpatient (if affebrile without respiratory distress)
      1. Consider initial parenteral antibiotic at diagnosis
        1. Ceftriaxone 50 mg/kg/day up to 1 gram IM x1 dose
        2. Start oral antibiotics concurrently as below
      2. First-line oral agents
        1. Amoxicillin 90 mg/kg/day PO divided q8 hours x7-10d
      3. Alternative oral agents
        1. Amoxicillin-Clavulanic Acid (Augmentin) or
        2. Erythromycin or
        3. Clarithromycin or
        4. Azithromycin
    2. Inpatient (if febrile or hypoxic)
      1. Cefotaxime 150 mg/kg/day IV divided q6 hours or
      2. Cefuroxime 150 mg/kg/day IV divided q8 hours or
      3. If confirmed Pneumococcal Pneumonia
        1. Ampicillin alone 200 mg/kg/day divided q8 hours
    3. Critically ill
      1. Option 1
        1. Cefotaxime 150 mg/kg/day IV divided q6 hours and
        2. Erythromycin 40 mg/kg/day IV divided q6 hours
      2. Option 2
        1. Cefuroxime 150 mg/kg/day IV divided q8 hours and
        2. Cloxacillin 150-200 mg/kg/day IV divided q6 hours
  6. Management: Age 5 to 18 years
    1. Outpatient
      1. First-line oral agents
        1. Erythromycin 40 mg/kg/day divided q6 hours x7-10d
        2. Clarithromycin 15 mg/kg/day divided q12 hour x7-10d
        3. Azithromycin
          1. Day 1: 10 mg/kg day 1 (maximum 500 mg)
          2. Days 2-5: 5 mg/kg per day (maximum 250 mg)
      2. Pneumococcal Pneumonia confirmed
        1. Amoxicillin 90 mg/kg/day PO divided q8 hours x7-10d
    2. Inpatient
      1. First line and in critical illness
        1. Cefuroxime 150 mg/kg/day IV divided q8 hours and
        2. Erythromycin 40 mg/kg/day IV divided q6 hours
      2. Pneumococcal Pneumonia confirmed
        1. Ampicillin 200 mg/kg/day IV divided q8 hours
  7. References
    1. McIntosh (2002) N Engl J Med 346:429
    2. Nelson (2000) Pediatr Infect Dis 19:251
    3. Ostapchuk (2004) Am Fam Physician 70(5):899

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