Ira Shah
Pneumonia - Treatment
Oxygen is required if there is grunting, flaring, severe tachypnea, and retractions.

Bacterial Pneumonia: Antibiotics: oral or intravenous
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.

Pneumonia Pneumonia 01/02/2001
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