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Viral and Bacterial Pneumonia in Children

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... IV/IM Clarithromycin 15 mg ... pertussis Etiology 2 to 5 years Overall rate decreased Bacterial increase in proportion S. pneumoniae Hib sharply decreased ... – PowerPoint PPT presentation

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Title: Viral and Bacterial Pneumonia in Children


1
Viral and Bacterial Pneumonia in Children
  • Tintinalli Chapter 123

2
Epidemiology
  • Incidence of pneumonia decreases as a function of
    age in children
  • Seasonal variation
  • Fall
  • Parainfluenza virus
  • Winter
  • RSV
  • Bacterial pneumonia (due to indoor crowding)
  • Spring
  • Influenza

3
Etiology
  • Birth 1 month
  • Bacterial gt Viral
  • Aspiration of maternal genital organisms
  • B. Strep
  • E. coli
  • 1 to 24 months
  • Viruses most common
  • RSV, parainfluenza virus, influenza virus, adeno
    virus
  • Apneic episodes
  • RSV, chlamydia, pertussis

4
Etiology
  • 2 to 5 years
  • Overall rate decreased
  • Bacterial increase in proportion
  • S. pneumoniae
  • Hib sharply decreased after vaccine
  • Viruses
  • Influenza A and B, adenovirus

5
Etiology
  • School age and adolescence
  • M. pneumoniae most common bacterial cause
  • Peak 10 15 years

6
Clinical features
  • Highly variable
  • Tachypnea most frequent
  • Lung sounds
  • Typical - Fever, chills, pleuritic chest pain,
    productive cough
  • Atypical Gradual onset, malaise, headache,
    nonproductive cough, low grade fever

7
Clinical features
  • Associated findings
  • Wheezing, rhinitis, conjunctivitis, pharyngitis
  • Dehydration
  • Mental status changes in advanced

8
Diagnosis
  • Differentiate from non infections congenital
    disorders
  • Radiograph
  • Labs
  • CBC with diff, Blood culture when indicated, ESR
  • Viral antigen tests, sputum culture
  • Fluids

9
Disposition
  • Admission considerations
  • Hypoxia
  • Age lt 3 months
  • Toxic appearance
  • Respiratory distress
  • History of apnea
  • Impaired immunity
  • Desaturation with crying
  • Dehydration
  • Preexisting lung disease
  • Underling medical condition
  • Parental reliability

10
Treatment
  • SpO2 (93 is consensus admission mark)
  • ABCs
  • Antibiotics
  • Amoxicillin 40 mg/kg divided TID, PO
  • Ampicillin 150 mg/kg divided QID, IV/IM
  • Azithromycin 10 mg/kg the 5 mg/kg x 4 days PO
  • Cefotaxime 150 mg/kg divided TID, IV/IM
  • Ceftazidime 50 mg/kg divided TID, IV/IM
  • Cefuroxime 150 mg/kg divided TIS, IV/IM
  • Clarithromycin 15 mg/kg divided BID, PO
  • Erythromycin 40 mg/kg divided QID, PO/IV
  • Gentamicin 2.5 mg/kg divided TID, IV/IM

11
Treatment
  • Atypical agents for unusual pneumonia
  • Varicella pneumonia Acyclovir
  • RSV Ribavirin, if high risk
  • HIV Prednisone and zidovudine
  • CMV Gabcyclovir and Gamma globulin
  • Gram negative organism Ceftazidime
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