This clinical guideline provides recommendations for diagnosing and treating pneumonia in children. Pneumonia is common in children under 2 years old and can be caused by bacteria, viruses, or mixed infections depending on the child's age. Clinical features like fever, cough, difficulty breathing, and fast breathing should prompt consideration of pneumonia. Chest x-rays are not needed for most cases but can help in complicated cases. Most children can be treated with oral antibiotics at home, while those with more severe symptoms require hospital admission and intravenous antibiotics. Complications like lung abscesses may occur and require longer treatment and follow up to ensure full recovery. Recurrent pneumonia may indicate underlying conditions that require further investigation.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs). The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces
Banadir Hospital Pediatric Departments
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs). The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear.
prdiatrics notes, croup, upper respiratoty track infection
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/11/pediatrics-notes-croup.html
Fever, common cold and cough in pediatric age groups are common. Acute bronchiolitis is a diagnostic term used to describe the clinical picture produced by several different lower respiratory tract infections in infants and very young children (younger than 1yr ,some clinicians extend it to the age of 2 yr). Pneumonia defined as inflammation of lung parenchyma.
It is the leading infectious cause of death globally among children younger than 5 yr.
The introduction of antibiotics and vaccine against measles , pertussis ,haemophilus influenzae type b and PCV vaccine reduces the pneumonia related mortality over past 15 yr.
Whooping cough | pertussis ( medical information ) - a detailed studymartinshaji
Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop." Before the vaccine was developed, whooping cough was considered a childhood disease.
this chart comprises all the major aspects of whooping cough / pertussis
please comment
thank u
Ppt about pediatric pneumonia, the definition, causes, pathological background, presentation, radiological findings and management.
It's prepared by doctor Musab MohamedAlamin Abdalla Hamid, a Sudanese doctor graduated from Omdurman Islamic University Faculty of Medicine and health siences
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 1 of 8
• Introduction
• Clinical features
• Causative Organisms
• Investigations
• Treatment
• Admission
• Follow-up
• Recurrent pneumonia or persistent
symptoms
• Complications
• Prevention: Environment & underlying
conditions
• References
IntroductionIntroductionIntroductionIntroduction
These guidelines may not be appropriate for the immunocompromised child or a child with chronic
lung disease (e.g. cystic fibrosis, bronchiectasis, neonatal chronic lung disease).
Pneumonia, bronchiolitis and asthma are all common illnesses that result in children presenting
with acute lower respiratory symptoms and signs. Antibiotics should be given to children with
bacterial pneumonia but not to children with bronchiolitis or asthma.
The New Zealand population has high rates of pneumonia, complicated pneumonia and long term
sequelae (eg bronchiectasis). Pneumonia is more common and more severe in younger children.
In Auckland the hospitalisation rate of those < 2 years is 11 times higher than those aged ≥ 4.
Clinical FeaturesClinical FeaturesClinical FeaturesClinical Features
Most children with pneumonia present with cough or difficulty breathing, but only the minority of
children with these symptoms have pneumonia. Bacterial pneumonia should be considered in
children <3 years of age who present with fever > 38.5, chest recession and increased respiratory
rate >50 breaths/minute. Older children with bacterial pneumonia often present with difficultly
breathing in combination with tachypnoea. If wheeze is present in a preschool child, primary
bacterial pneumonia is unlikely however in school age children it may suggest Mycoplasma
pneumoniae (see below).
Tachypnoea is a key clinical sign
Tachypnoea by age (World Health Organisation)
< 2 months age > 60 breaths per minute
2- 12 months age > 50 breaths per minute
12 months to 5 years age > 40 breaths per minute
If chest indrawing, nasal flaring, grunting or crepitations are also present then the probability of
pneumonia is increased further. Atypical presentations without obvious respiratory symptoms are
not rare (abdominal pain and vomiting mimicking an acute abdomen, meningism mimicking
meningitis).
2. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 2 of 8
Causative OrganismsCausative OrganismsCausative OrganismsCausative Organisms
In developed countries the aetiology of community acquired pneumonia has been defined by the
child’s age as well as the severity of the episode of illness. Likely causative organisms by age
group are shown in Table 1. Mycoplasma pneumoniae should be suspected in school age
children especially if the onset of symptoms is insidious and/or the child has wheeze, headache or
arthralgia. Cold agglutinins and serial mycoplasma serology may be helpful in confirming
mycoplasma but seldom influence management decisions so aren’t routinely recommended.
Table 1: Aetiology of Pneumonia by Age Group in Developed Countries*
Age group Predominant organisms**
0 to 1 months Group B streptococcus
Gram negative organisms
Chlamydia trachomatis
Listeria monocytogenes
1 to 24
months
Respiratory syncytial virus (RSV) and other viruses †
Streptococcus pneumoniae
Haemophilus influenzae (non typeable)
Bordetella pertussis
2 to 5 years Respiratory syncytial viruses (RSV)
and other viruses †
Streptococcus pneumoniae
Haemophilus influenzae (non typeable)
6 to 18 years Mycoplasma pneumoniae
Chlamydia pneumoniae
Streptococcus pneumoniae accounts for up to 30%
Respiratory viruses account for < 15% of episodes
* The proportion of pneumonia due to bacteria increases with age and within each age group
likelihood of bacterial infection increases with increasing severity.
†
Other respiratory viruses = Influenza A and B, parainfluenzae 1-3 , adenoviruses, human
metapneumovirus, human coronavirus. Mixed bacterial and viral infection can occur in up to 40%.
** Staphylococcus aureus is an important pathogen of serious pneumonia to remember in
all age groups
InvestigationsInvestigationsInvestigationsInvestigations
Many children with pneumonia may be diagnosed and managed on clinical grounds alone.
Radiology does not reliably distinguish bacterial from viral pneumonia so does not determine the
need for antibiotics. A chest x-ray may be indicated if:
• Presentation is atypical
• There is diagnostic uncertainty
• Infants <3 months of age
• Child who is severely unwell
• Child has a history suggesting underlying respiratory disease
• Complications (such as effusion) are suspected (based on clinical signs or not making
anticipated clinical progress).
3. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 3 of 8
Sputum, throat swabs and NPA for bacterial cultures do not help determine who should receive
antibiotics. An NPA may be indicated for cohorting patients being admitted, for diagnosis of
suspected viral pneumonia (< 2years) and deciding who may benefit from antiviral medication such
as oseltamavir.
A blood culture is an insensitive test for bacterial pneumonia in children however blood cultures
should be considered in the unwell child with pneumonia, especially the child suspected of having
Staphylococcus aureus or complicated pneumonia. Fever magnitude, full blood count findings or
CRP do not reliably differentiate viral from bacterial pneumonia.
TreatmentTreatmentTreatmentTreatment
Children suspected with bacterial pneumonia should be treated with antibiotics. Antibiotics do not
prevent pneumonia in children with upper respiratory tract infections. In contrast to pneumococcal
meningitis, respiratory infections with pneumococci with reduced susceptibility to penicillin have not
been shown to have worse outcomes and decreased susceptibility can be overcome with the use
of high oral or IV dosing of penicillin.
1. Oral Antibiotics
Oral antibiotics will provide adequate coverage for most mild to moderate episodes of pneumonia.
This may include some of those requiring admission. There is no role for outpatient oral antibiotic
therapy for infants < 3 months of age with pneumonia.
Age Antibiotic Dose Duration
3 months to 5 years High dose amoxycillin 30 mg/kg/dose TDS*,
maximum 500mg/dose
5-7 days
≥ 5 years High dose amoxycillin 30 mg/kg/dose TDS*
Maximum 1000mg/dose
5-7 days
Erythromycin, 12.5mg/kg/dose QID≥ 5 years, Mycoplasma
pneumonia suspected
OR, Roxithromycin
(tablets only)
4mg/kg, BD
7-10 days
* Oral amoxycillin dose has been increased from previous guidelines in view of increased
pneumococcal resistance (consistent with international best practice).
4. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 4 of 8
2. Parenteral antibiotics
Should only be used for those requiring admission (see below)
A) Pneumonia Not Likely To Be Staphylococcal
Suggested empirical IV therapy for inpatients with uncomplicated pneumonia (no suspicion of
staphylococcal disease, no lung abscess nor pleural effusions) is:
Age Antibiotic Dose Interval
(hrs)
Less than 3 months Cefotaxime +
Amoxycillin
50 mg/kg/dose
50 mg/kg/dose
8i
6ii
≥ 3 months
(fully immunisediv
)
Amoxycillin 30- 50 mg /kg/dose
(maximum 2000 mg / dose)
8
i. In term babies < 7 days old, reduce to 12 hourly
ii. In term babies < 7 days old, reduce to 8 hourly
iii. In a child > 5 years, if suspicion of mycoplasma consider addition of an oral macrolide
iv. Unimmunised children should be treated according to the complicated pneumonia
recommendations below.
Duration of therapy is determined by clinical response. Intravenous therapy should be used until
the child is afebrile and, in the case of severe pneumonia, for several days after this.
Total duration of therapy is usually 7 -10 days.
Monitor pulse rate, respiratory rate, temperature, and oxygen saturation.
B) Complicated pneumonia
< 3 months Cefotaxime and amoxycillin
as above
≥3 months Amoxycillin + Clavulanic
acid*
OR
Cefuroxime*
30mg/kg/dose
(max 1.2g/dose
q6h)
30mg/kg/dose
(max 1.5g/dose)
6-8 hourly
8 hourly
* Following intravenous treatment options for oral antibiotics include amoxycillin-clavulanic acid
syrup/tablets or cephalexin syrup/tablets
5. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 5 of 8
C) Probable Staphylococcal Pneumonia
Staphylococcal pneumonia is classically associated with lung abscess and empyema. Consider it
in any child who is very unwell, has abscesses or metastatic infection or has developed pneumonia
as a consequence of chicken pox, influenza or measles. Diagnosis should be confirmed by blood
culture and/or aspirate. Staphylococcal pneumonia is a medical emergency – if you suspect it, you
must discuss the child with your consultant.
Appropriate initial IV antibiotics for probable S.aureus pneumonia are:
Flucloxacillin
+/-
Clindamycin*
50mg/kg
(max 2000mg/dose)
10mg/kg
(max 450mg/dose)
6 hourly
6-8 hourly
*Addition of clindamycin should be based on local methicillin resistant Staphylococcus aureus rate
where >10% is suggestive of need to add anti-MRSa drug. *ID approval is required for use of
Clindamycin >48 hours
• Multi-resistant-S.aureus remains uncommon as a cause of pneumonia, so Vancomycin is
rarely required as empiric treatment.
• Antibiotic choice should be rationalised once culture results available.
AdmissionAdmissionAdmissionAdmission
Indications for admission include any of the following:
• Ill or toxic appearance.
• Age < 3 months.
• Hypoxaemia: oxygen saturation less than 93% on air
• Respiratory distress interfering significantly with feeding.
• Significant dehydration.
• Complicated pneumonia.
• Deterioration despite appropriate oral antibiotics.
• Significant co-morbidity
• Social concerns: no car, no phone, language or communication barrier
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Most children with pneumonia respond to quickly to treatment and make uneventful, full recoveries.
Resolution of cough is expected in 4-6 weeks and when this does not occur the family should see
their General Practitioner for further follow up and consideration of referral to General Paediatric
outpatient clinic. A follow up chest x-ray is not routinely required but may be indicated in those with
complicated pneumonia – see below, (including significant atelectasis / collapse) or chronic /
recurrent symptoms.
6. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 6 of 8
Children with recurrent pneumonia or persistent symptomsChildren with recurrent pneumonia or persistent symptomsChildren with recurrent pneumonia or persistent symptomsChildren with recurrent pneumonia or persistent symptoms
A history of recurrent pneumonia or chronic cough / respiratory symptoms should be sought at
admission. This may be a sign of underlying vulnerabilities, chronic lung disease or environmental
factors (see table below). History & clinical examination is the best starting point to investigate
further.
See Starship Guideline on ‘COUGH - investigation of chronic cough &/or confirmed bronchiectasis’
The child with recurrent pneumonia or persistent symptoms needs referral to General Paediatric
outpatient clinic with further investigations arranged. It may be appropriate to discuss this referral
prior to discharge from CED.
Pneumonia ComplicationsPneumonia ComplicationsPneumonia ComplicationsPneumonia Complications
Health professionals caring for children with pneumonia should be aware of the range of potential
complications, how to recognise them and their management. The following serves to highlight
these complications but is not intended as a full list nor a comprehensive guide to their
management.
(a) Syndrome of inappropriate anti-diuretic hormone (SIADH): Inappropriate secretion of
anti-diuretic hormone leads to retention of water and hyponatraemia. This is recognised
frequently in paediatric respiratory illness. Most children should be managed with ¾
maintenance (see Intravenous Fluids guideline). Consider symptomatic hyponatraemia if
there is irritability, an altered level of consciousness. Initial test is serum electrolytes. Seek
expert advice on management.
(b) Lung necrosis: Necrosis and liquefaction of lung tissue. Suspicion may be raised by poor
response to treatment, including persisting fever. Definitive diagnosis requires contrast
chest CT (see expert advice before requesting this). Additional therapy or surgical
intervention is not necessarily required and outcome with conservative management in
childhood is usually good. Careful follow up is required as long term sequelae may follow.
(c) Pneumatocoele: These are thin-walled air-filled cysts that develop within the parenchyma.
They are particularly associated with Staphylococcus aureus and will usually resolve over
time without specific intervention. Careful follow up is recommended to ensure full recovery
and resolution. Family should be notified that it may be unsafe for the child to fly while the
pneumatocoele(s) are present.
(d) Atelectasis / Lobar collapse: This is not uncommon. Chest physiotherapy (airway
clearance techniques) may be indicated. Follow up should be arranged to ensure resolution
as may be associated with long term sequelae. Children with persistent lobar collapse
should be referred to a respiratory paediatrician for review and potentially a flexible
bronchoscopy.
7. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 7 of 8
(e) Parapneumonic effusion / empyema: All children with pneumonia whose fever doesn’t
settle on appropriate antibiotic therapy within 48hrs should be screened for a pleural
collection (examination and chest x-ray). Children with parapneumonic effusions /
empyema should be admitted on intravenous antibiotics (see complicated pneumonia
above) to cover the likely organisms (Streptococcal species and Staphylococcus aureus
but tuberculosis should be considered). Baseline full blood count, inflammatory markers
and blood cultures are recommended. If the child is significantly compromised (high work
of breathing, hypoxia, and/or persistent signs of sepsis), aren't making expected progress,
or the effusion is very large, then additional intervention should be considered. This will
usually be video-assisted thorascopic surgery (VATS) with a chest drain or a chest drain
with fibrinolytic therapy. Both of these interventions result in more rapid recovery than a
chest drain or antibiotics alone. A chest ultrasound is useful pre-intervention to confirm,
quantify and characterise the effusion. Routine thoracocentesis or chest CT are not
recommended. If you aren't familiar with empyema management, seek expert advise.
(f) Lung abscess: The symptoms and signs of lung abscess are the same as for pneumonia
and they may be difficult to distinguish on clinical grounds alone. Diagnosis is usually made
by chest x-ray supported by contrast CT chest. The presence of underlying lung disease or
malformation, foreign body, aspiration, or immunodeficiency should be carefully considered.
Blood cultures, full blood count and inflammatory markers should be obtained at diagnosis.
Therapy is a prolonged course of antibiotics, usually a minimum of 4 weeks. Management
of lung abscess should be guided by a respiratory paediatrician.
(g) Chronic bronchitis / bronchiectasis (sequelae): Children with persistent symptoms
and/or signs including chronic productive cough, persistent crackles, clubbing and/or x-ray
findings should be evaluated further for possible underlying bronchitis/bronchiectasis.
See Starship Guideline on ‘COUGH - investigation of chronic cough &/or confirmed
bronchiectasis’
Prevention: Environment and underlying conditionsPrevention: Environment and underlying conditionsPrevention: Environment and underlying conditionsPrevention: Environment and underlying conditions
associated with pneumoniaassociated with pneumoniaassociated with pneumoniaassociated with pneumonia
Environmental factors Underlying conditions
• tobacco smoke exposure
• poor nutrition
• poor housing
• over-crowding
• lack of immunisation
• chronic lung diseases (chronic bronchitis /
bronchiectasis)
• cystic fibrosis
• primary immunodeficiency
• chronic aspiration
• congenital lung malformation
• airway malformation
8. Starship Children’s Health Clinical Guideline
Note: The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
PNEUMONIA
Author: Drs Best, Brabyn, Shepherd & Twiss Services: CED, Respiratory, ID, Gen Paeds
Editor: Dr Raewyn Gavin Date Reviewed: August 2010
Pneumonia Page: 8 of 8
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http://www.surv.esr.cri.nz/PDF_surveillance/Antimicrobial/MRSA/aMRSA_