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Viral and Bacterial Pneumonia in Children

Viral and Bacterial Pneumonia in Children

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Viral and Bacterial Pneumonia in Children

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  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 > 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 < 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