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Severe Pneumonia - Guidelines for Management

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Dr Narayanappa, Mysuru    15 January 2018

  1. Etiologic agent - Virus; Pneumococcus; Mycoplasma; Staphylococcus.
  2. Etiology of CAP in children: 0-3 months – Gram-negative bacilli; Chlamydia trachomatis; H. influenzae; Pneumococcus; Viral; 3 months-5 years – Viruses (RSV, Influenza, Parainfluenza, Adenovirus); H. influenzae; Pneumococcus; S. aureus; 5 years and above – Pneumococcus; Mycoplasma; Chlamydia; Viruses.
  3. Specific investigations for CAP: Sputum gram stain and culture, sputum AFB smear, blood culture, urine pneumococcal antigen, antimycoplasma IgM, PCR/DFA for respiratory viruses.
  4. Indications for IV antibiotics: Infants <3 months; respiratory distress, movement of alae nasi, subcostal and intercostal retraction; oxygen saturation <92% in room air; patient too sick to swallow.
  5. Choice of empirical therapy: Outpatient
AgeFirst-lineSecond-lineSuspected staph
3 months-5 yearsAmoxycillin/CotrimoxazoleCo-amoxiclav/Cefuroxime/CefpodoximeAmpicillin-Cloxacillin/Cefuroxime/Co-amoxiclav
5 years +AmoxycillinMacrolide/Co-amoxiclav/CefpodoximeAmpicillin-Cloxacillin/Cefuroxime/Co-amoxiclav
  1. Choice of empirical therapy: Inpatient
AgeFirst-lineSecond-lineSuspected staph
0-3 monthsCefotaxime/Ceftriaxone + AminoglycosideCo-amoxyclav + AminoglycosideCefotaxime/Ceftriaxone ± Vancomycin/Linezolid
3 months-5 yearsAmpicillin/Co-amoxyclav/CefuroximeCo-amoxiclav/ Cefotaxime/CeftriaxoneCefotaxime/Ceftriaxone + Cloxacillin ± Vancomycin/Linezolid
5 years +Ampicillin/Co-amoxiclav + MacrolidesCo-amoxiclav/Cefotaxime/Ceftriaxone + MacrolidesCefotaxime/Ceftriaxone + Cloxacillin ± Vancomycin/Linezolid
  1. Prompt diagnosis and early treatment are necessary.
  2. Nutrition and health education are important.
  3. Prevent complications by adequate monitoring and interventions.
  4. Follow specific vaccination.

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