PNEUMONIA

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Last Updated : 3/5/2007
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Ira Shah
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Oxygen is required if there is grunting, flaring, severe tachypnea, and retractions.

Bacterial Pneumonia

: Antibiotics: oral or intravenous
Penicillins:
They are appropriate first-line agents in children in whom pneumococcal disease is strongly suspected. They have limited activity against gram-negative bacteria due to resistance.
* Amoxicillin: 40 mg/kg/day PO divided tid/ 100 mg/kg/day IV qds
* Penicillin V: 40 mg/kg/d PO divided qid
* Crystalline Penicillin: 1,00,000 units/kg/day IV in 6 divided doses.
* Ampicillin/Sulbactam: 40mg/kg/day PO divided tid, 100 mg/kg/day IV qds
* Amoxicillin/clavulanic acid: 40mg/kg/day PO divided tid, 100 mg/kg/day IV qds

First generation cephalosporins:
They are useful against gram positive organisms and Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis.
- Cephalexin: 50 mg/kg/day PO bid
- Cefadur : 30-50 mg/kg/day PO bid.
- Cefuroxime: 30 mg/kg/d PO bid, IV: 150-200 mg/kg/d IV divided q8h.
- Cefalothin: 50 mg/kg/day PO qds / 100 mg/kg/day IV qds.

Second generation cephalosporin:
They are useful against gram positive organisms and have limited activity against gram negative organisms.
- Cefaclor: 20-40 mg/kg/day PO tds

Third generation cephalosporins:
They are broad-spectrum antibiotics having good gram-negative activity.
- Cefixime: 8 mg/kg/day PO bid.
- Ceftriaxone: 50-100 mg/kg/d IV/IM bd not to exceed 1 g.
- Cefotaxime: 100-200 mg/kg/d IV/IM divided q6-8h.
- Cefpodoxime: 10 mg/kg/d PO divided bid
- Cefprozil: 30 mg/kg/d PO divided bid

TMP-SMX: 21 mg/kg/day PO/IV for 21 days. Useful for PCP pneumonia.

Macrolides: They are used for treatment of staphylococcal and streptococcal infections. Also used in the treatment of atypical pneumonias due to mycoplasma, chlamydias.

Viral pneumonia


- RSV: Serious infections with this organism usually occur in infants with underlying lung disease. Aerosolized ribavirin can be given to severely affected infants.
- Herpes virus: Acyclovir is available for treatment of these pneumonias. Dose: 10 mg/kg/dose IV q8h; infuse over 1 h
- Influenza pneumonia, which is particularly severe or when it occurs in a high-risk patient, may be treated with oseltamivir

Children who are toxic:
Antibiotic therapy should include vancomycin (particularly in areas where penicillin resistant streptococci have been identified) and a cephalosporin.

Prevention
Pneumococcal vaccine should be given to children with asplenia or sickle cell disease or have undergone splenectomy. A

new conjugated pneumococcal vaccine

has been developed and is recommended as a part of the routine childhood immunization schedule.

Conjugated Haemophilus influenzae type B vaccine is recommended as a part of the routine childhood immunization schedule and has reduced the incidence of infections caused by this organism.

Varicella vaccine
is especially recommended in children who are immunocompromised or adults who are unprotected.

Influenza vaccines
can be given in high risk patients.



Contributor Information and Disclosures Ira Shah
Consultant Pediatrician, B.J.Wadia Hospital for Children, Mumbai, India


First Created : 1/2/2001
References
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