Pulmonology Book

http://www.fpnotebook.com/

Pneumonia Management in Children

Aka: Pneumonia Management in Children
  1. See Also
    1. Pneumonia
    2. Pneumonia in Children
    3. Pneumonia Causes in Children
    4. Pneumonia Management
    5. RSV Pneumonia
    6. Respiratory Distress in Children with Pneumonia
    7. Pediatric Early Warning Score (PEWS Score)
  2. Management: General
    1. See Pneumonia Management
    2. See age directed management below
  3. Indications: Hospitalization
    1. Respiratory distress (Apnea, grunting, nasal flaring)
      1. See Respiratory Distress in Children with Pneumonia
      2. See Pediatric Early Warning Score (PEWS Score)
    2. Hypoxemia (<90% Oxygen Saturation) or Cyanosis
    3. Virulent pathogen suspected (e.g. MRSA)
    4. All infants under age 4 months (consider in children under 6 months)
    5. Toxic appearance
    6. Dehydration with Vomiting or poor oral intake
    7. Immunocompromised patient
    8. Pneumonia refractory to oral antibiotics
    9. Unreliable home environment
    10. (2002) Thorax 57:i1-24 [PubMed]
  4. Indications: PICU admission
    1. Mechanical Ventilation or CPAP
    2. Impending respiratory failure
    3. Shock state
    4. Pulse Oximetry <92% despite Supplemental Oxygen with FIO2 50% or higher
    5. Altered Mental Status
  5. 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
          1. Weight <2 kg: 2.5 mg/kg IV every 18 to 24 hours
          2. Weight >2 kg: 2.5 mg/kg IV every 12 hours
        2. Age >7 days
          1. Dose: 2.5 mg/kg IV every 12 hours
      3. Antibiotic 3: Cefotaxime (optional)
        1. Age <7 days: 50 mg/kg IV every 12 hours
        2. Age >7 days: 50 mg/kg IV every 8 hours
    3. Organisms requiring additional antibiotic coverage
      1. Methicillin Resistant Staphylococcus Aureus (MRSA): Choose 1
        1. Vancomycin
          1. Age <7 days
            1. Weight <2 kg: 12.5 mg/kg IV every 12 hours
            2. Weight >2 kg: 15 mg/kg IV every 12 hours
          2. Age >7 days
            1. Weight <2 kg: 18 mg/kg IV every 12 hours
            2. Weight >2 kg: 22 mg/kg IV every 12 hours
        2. Linezolid
          1. Dose: 10 mg/kg every 8 hours
      2. Chlamydia trachomatis
        1. Erythromycin 12.5 mg/kg orally or IV every 6 hours for 14 days
  6. Management: Age 3 weeks to 3 months
    1. Precautions
      1. Erythromycin is associated with increased risk of Hypertrophic Pyloric Stenosis in infants under 6 weeks of age
      2. No empiric therapy is needed for Staphylococcus aureus coverage as this rarely occurs in this age group
    2. Outpatient (if affebrile without respiratory distress)
      1. Azithromycin 10 mg/kg (max 500 mg) orally on day 1 then 5 mg/kg (max 250 mg) orally on days 2 to 5 or
      2. Erythromycin 12.5 mg/kg orally every 6 hours for 14 days
    3. Inpatient (if febrile or hypoxic)
      1. Macrolide
        1. Azithromycin 10 mg/kg (max 500 mg) IV on day 1 then 5 mg/kg (max 250 mg) IV on days 2 to 5 or
        2. Erythromycin 10 mg/kg IV every 6 hours
      2. Febrile
        1. Add Cefotaxime 50 mg/kg IV every 8 hours
      3. Lobar Pneumonia (presumed Streptococcus Pneumoniae)
        1. Add Ampicillin 50-75 mg/kg IV every 6 hours
  7. Management: Age 3 months to 5 years (outpatient)
    1. See inpatient antibiotic selection below
    2. Precautions
      1. Viral Pneumonia (esp. Influenza, RSV) predominates in preschool children
        1. Most common in under age 2 years old
        2. Viral PneumoniaIncidence decreases with age
      2. Empiric antibiotic therapy is not recommended unless Bacterial Pneumonia is suspected
        1. Coverage below first addresses Streptococcus Pneumoniae coverage
        2. Streptococcus Pneumoniae has increasing resistance to Macrolide antibiotics (e.g. Azithromycin)
      3. May treat as outpatient if patient affebrile without respiratory distress
    3. First-line oral agent for presumed Bacterial cause (choose one)
      1. Amoxicillin (preferred)
        1. Dose: 45 mg/kg/day orally divided every 12 hours for 5 days
        2. Hazir (2008) Lancet 371(9606): 49-56 [PubMed]
      2. Augmentin (alternative)
        1. Dose: 45 mg/kg every 12 hours
    4. Presumed Atypical Pneumonia (choose one)
      1. Azithromycin
        1. Dose: 10 mg/kg (max 500 mg) orally on day 1 then 5 mg/kg (max 250 mg) orally on days 2 to 5
      2. Clarithromycin
        1. Dose: 7.5 mg/kg twice daily for 7 to 14 days
      3. Erythromycin
        1. Dose: 10 mg/kg orally four times daily
    5. Consider initial parenteral antibiotic at diagnosis
      1. See inpatient antibiotic regimen below
      2. Start oral antibiotics concurrently as below
    6. Influenza suspected
      1. Oseltamavir (Tamiflu)
  8. Management: Age 5 to 18 years (outpatient)
    1. See inpatient antibiotic selection below
    2. Approach
      1. Choose an agent based on typical versus atypical Bacterial cause suspected
      2. In more severe cases, or in which typical can not be distinguished from each other
        1. Choose an antibiotic from each category (one from typical, one from atypical)
    3. Typical Bacterial Pneumonia (i.e. Streptococcus Pneumoniae): Choose one
      1. Amoxicillin (preferred)
        1. Dose: 45 mg/kg/day orally divided every 12 hours for 5 days
        2. Hazir (2008) Lancet 371(9606): 49-56 [PubMed]
      2. Augmentin (alternative)
        1. Dose: 45 mg/kg every 12 hours
    4. Presumed Atypical Bacterial Pneumonia: Choose one
      1. Azithromycin
        1. Dose: 10 mg/kg (max 500 mg) orally on day 1 then 5 mg/kg (max 250 mg) orally on days 2 to 5
      2. Clarithromycin
        1. Dose: 7.5 mg/kg twice daily for 7 to 14 days
      3. Erythromycin
        1. Dose: 10 mg/kg orally four times daily
      4. Doxycycline (use only if over age 8 years)
        1. Dose: 100 mg orally every 12 hours
    5. Consider initial parenteral antibiotic at diagnosis
      1. See inpatient antibiotic regimen below
      2. Start oral antibiotics concurrently as below
    6. Influenza suspected
      1. Oseltamavir (Tamiflu) or
      2. Zanamavir
        1. Indicated only for children 7 years or older
  9. Management: Age 3 months to 18 years (inpatient, parenteral)
    1. See outpatient antibiotics above
    2. Primary Antibiotic (choose one)
      1. Fully immunized and not life-threatening infection
        1. Ampicillin 12.5 mg/kg IV every 6 hours (preferred)
      2. Not fully immunized against S. Pneumoniae and H. Influenzae or life-threatening infection
        1. Cefotaxime 50 mg/kg IV every 8 hours or
        2. Ceftriaxone 50 to 100 mg/kg/day up to 1-2 g/day divided every 12 to 24 hours
    3. Atypical Pneumonia suspected (choose one)
      1. Add Azithromycin 10 mg/kg (max 500 mg) IV on day 1 then 5 mg/kg (max 250 mg) IV on days 2 to 5 or
      2. Add Erythromycin 40 mg/kg/day IV divided q6 hours or
      3. Add Clarithromycin 7.5 mg/kg twice daily for 7 to 14 days
    4. MRSA suspected (choose one)
      1. Add Vancomycin 14 to 20 mg/kg IV every 8 hours or
      2. Add Linezolid (Zyvox) 10 mg/kg IV/PO every 8h or if >12 yo, 600 mg PO/IV twice daily
      3. Add Clindamycin 14 mg/kg IV every 8 hours or
        1. If patient stable without bacteremia and Clindamycin resistance <10%
  10. Management: Adjunctive measures
    1. Zinc supplementation in critically ill children with Pneumonia
      1. Zinc supplementation associated with decreased mortality, shorter hospitalizations and fewer treatment failures
      2. Greatest benefit appears to be in developing countries where Zinc Deficiency occurs frequently (30% of world population)
      3. Basnet (2012) Pediatrics 129(4): 701-8 [PubMed]
      4. Srinivasan (2012) BMC Med 10: 14 [PubMed]
  11. References
    1. Gilbert (2011) Sanford Guide to Antimicrobial Therapy
    2. Bradley (2011) Clin Infect Dis 53(7): e1-52 [PubMed]
    3. McIntosh (2002) N Engl J Med 346:429-37 [PubMed]
    4. Nelson (2000) Pediatr Infect Dis 19:251-3 [PubMed]
    5. Ostapchuk (2004) Am Fam Physician 70(5):899-908 [PubMed]
    6. Stuckey-Schrock (2012) Am Fam Physician 86(7): 661-7 [PubMed]

Pneumonia (C0032285)

Definition (MSH) Inflammation of any part, segment or lobe, of the lung parenchyma.
Definition (MEDLINEPLUS)

Pneumonia is an infection in one or both of the lungs. Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. You can also get pneumonia by inhaling a liquid or chemical. People most at risk are older than 65 or younger than 2 years of age, or already have health problems.

Symptoms of pneumonia vary from mild to severe. See your doctor promptly if you

  • Have a high fever
  • Have shaking chills
  • Have a cough with phlegm that doesn't improve or gets worse
  • Develop shortness of breath with normal daily activities
  • Have chest pain when you breathe or cough
  • Feel suddenly worse after a cold or the flu

Your doctor will use your medical history, a physical exam, and lab tests to diagnose pneumonia. Treatment depends on what kind you have. If bacteria are the cause, antibiotics should help. If you have viral pneumonia, your doctor may prescribe an antiviral medicine to treat it.

Preventing pneumonia is always better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI_NCI-GLOSS) A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.
Definition (NCI) An acute, acute and chronic, or chronic inflammation focally or diffusely affecting the lung parenchyma, due to infections (viruses, fungi, mycoplasma, or bacteria), treatment (e.g. radiation), or exposure (inhalation) to chemicals. Symptoms include cough, shortness of breath, fevers, chills, chest pain, headache, sweating, and weakness.
Definition (CSP) inflammation of the lungs with consolidation and exudation.
Concepts Disease or Syndrome (T047)
MSH D011014
ICD10 J18.9
SnomedCT 274103002, 155552002, 155558003, 266391003, 155548002, 60363000, 205237003, 233604007
LNC LP21407-9, MTHU020831, LA7465-3
English Pneumonitis, Pneumonia, Pneumonias, Pneumonia, unspecified, Pneumonitides, Pneumonia NOS, pneumonia (diagnosis), pneumonia, Pneumonitis NOS, Pneumonia [Disease/Finding], Pneumoniae, inflammation lungs, unspecified pneumonia, pneum, pulmonary inflammation, lung inflammation, Inflammation, Lung, Inflammation, Pulmonary, Inflammations, Lung, Inflammations, Pulmonary, Lung Inflammation, Lung Inflammations, Pulmonary Inflammation, Pulmonary Inflammations, Pneumonia NOS (disorder), Pulmonary inflammation, Lung inflamed, Pulmonitis, PNEUMONIA, Pneumonia (disorder), Pneumonia, NOS, Pneumonia (disorder) [Ambiguous], pneumonitis
French PNEUMONIE, Congestion pulmonaire SAI, Pneumonite, Pneumonie SAI, Pneumopathie infectieuse, Pneumonie
Portuguese PNEUMONIA, Pneumonite NE, Pulmonite, Pneumonia NE, Pulmonia, Pneumonia, Inflamação do Pulmão, Inflamação Pulmonar, Pneumonite
Spanish NEUMONIA, Neumonitis NEOM, Neumonía NEOM, neumonia, SAI (trastorno), Pneumonia NOS, neumonia, SAI, Pneumonía, Pulmonía, neumonía (concepto no activo), neumonía (trastorno), neumonía, Neumonitis, Inflamación del Pulmón, Inflamación Pulmonar, Neumonía
German PNEUMONIE, Pneumonie NNB, Pulmonitis, Pneumonitis NNB, Pneumonie, nicht naeher bezeichnet, Lungenentzuendung, Pneumonie, Pneumonitis, Lungenentzündung
Italian Infezione polmonare, Polmonite aspecifica, Infezione dei polmoni, Infezione polmonare aspecifica, Pneumonite, Infiammazione del polmone, Infiammazione polmonare, Polmonite
Dutch pneumonie NAO, pneumonitis NAO, pulmonitis, Pneumonie, niet gespecificeerd, pneumonie, Pneumonie, Longontsteking, Pneumonitis
Japanese 肺炎NOS, 肺臓炎, 肺臓炎NOS, ハイエンNOS, ハイエン, ハイゾウエンNOS, ハイゾウエン, 肺炎
Swedish Lunginflammation
Czech pneumonie, Pneumonie, Pulmonitida, Pneumonie NOS, Pneumonitida NOS, zápal plic, zánět plic
Finnish Keuhkokuume
Russian PNEVMONIIA, ПНЕВМОНИЯ
Korean 상세불명의 폐렴
Croatian PNEUMONIJA
Polish Zapalenie płuc
Hungarian pneumonia, Pneumonitis k.m.n., pneumonia k.m.n., Pulmonitis
Norwegian Pneumoni, Lungebetennelse
Sources
Derived from the NIH UMLS (Unified Medical Language System)


You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree