Severe Pneumonia - Guidelines for Management


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.

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.