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Pediatrics Pneumonia Meningitis
Pediatrics Pneumonia Meningitis
•
Aspiration pneumonia is caused by
Anaerobic bacteria (Bacteroides spp,
Fusobacterium spp., Prevotella spp,and
anaerobic gram-positive cocci)
•
Pathophysiology
Microorganisms gain access to LRT by three routes:
• Inhaled as aerosolized particles
• Enter the lung via bloodstream from an
extrapulmonary site of infection
• Aspiration of oropharyngeal contents may occur.
Cont.
• Local host defenses of the LRT include cough,
mucociliary antibodies, and alveolar macrophages
• Once breakdown of local host defenses occurs and
organisms invade lung tissue, an inflammatory
response is generated either by organisms causing
tissue damage or by immune response to the
presence of organisms
Risk factor
• Environmental crowding
• Underlying cardiopulmonary disorders
• Congenital and acquired immunodeficiency disorders
• Exposure to cigarette smoke, especially if the mother
smokes it increases the risk for pneumonia in infants
younger than 1 year of age.
• Malnutrition
• Trauma
• Anesthesia
• Aspiration
Clinical presentation
• Cough: chief symptom
• Increased respiratory rate
•
Cont.
• Tachypnea
• Retractions, and
• Hypoxemia
• They may have other constitutional symptoms,
such as
• headache,
• pleuritic chest pain, and
• nonspecific abdominal pain
Cont.
Severe pneumonia is manifested when
• Cough or difficulty in breathing with:
• Oxygen saturation < 90% or central cyanosis
• Severe respiratory distress (e.g. grunting, very
severe chest indrawing)
Signs of pneumonia with a general danger sign
• Inability to breastfeed or drink
• Lethargy or reduced level of consciousness
• Convulsions
• Vomiting everything
Complications
• Pneumothorax
• Septicaemia
• Pleural effussions
• Empyema
• Abscess
• Bronchiectasis
• Infective endocarditis
• Hem. Dissemination –sepsis, meningitis pericardtis
arthritis etc
Diagnosis
• Chest radiograph - A dense lobar or segmental
infiltrate or patchy consolidation
• fast breathing:
• age 2–11 months, ≥ 50/min
• age 1–5 years, ≥ 40/min
• lower chest wall indrawing
• Hypoxic or other clinical symptoms
Treatment
The Goal of therapy is to:
• Eliminate the patient’s symptoms,
• Minimize or prevent complications, and
• Decrease mortality
• Alleviate symptoms
• Prevent respiratory failure
• Prevent complications
Non pharmacological treatment
• Soothe the throat; relieve the cough with a safe
remedy
Safe remedies to recommend include:
• Breast milk for exclusively breast-fed infant
• Home fluids such as tea with honey, fruit juices
• Give oxygen if SpO2 < 90% with nasal prongs and
monitor through pulse oximetry for those in
respiratory distress via nasal cannula.
Pharmacologic therapy
Antipyretic
• Paracetamol, 10-15mg /kg P.O., up to 4-6 times a
day for the relief of high fever
Alternative
• Ibuprofen, 5 – 10mg/kg/dose every 6-8hr P.O.
(max. 40mg/kg/24hours).
Community acquired pneumonia
• The vast majority of children diagnosed with
pneumonia in the outpatient setting are treated
with oral antibiotics.
• The choice of an initial empiric agent is selected
according to the susceptibility and resistance
patterns of the likely pathogens.
Non-severe pneumonia
• High-dose Amoxicillin is used as a first-line agent for
children with uncomplicated community-acquired
pneumonia, which provides coverage for
Streptococcus pneumoniae
• Give the first dose at the clinic and teach the
mother how to give the other doses at home.
Cont.
First-line
• Amoxicillin, 30-50mg/kg every 12hours P.O for 5
days
Alternatives
• Azithromycin, 10mg/kg P.O., once daily for 3 days
mainly on patients that have afebrile pneumonia
syndrome.
• Reassess child for progress after 3 days.
Severe Pneumonia
• Benzyl penicillin, 50,000units/kg/24hours IV QID
for at least 3 days
• When the child improves switch to oral
• Amoxicillin: 30-50mg/kg/24 hours 3 times a day.
• The total course of treatment is 5-7days.
Cont.
• If the child doesn’t improve within 48 hours, switch
to ceftriaxone 80mg/Kg/24 hours IM/IV for 5 days
• If staphylococcus is suspected (empyema,
pneumatocele at X ray), give gentamicin 5 mg/kg
once daily plus cloxacillin 50 mg/kg IV every 6-hour
• Zinc supplementation in children <5years with
severe pneumonia
Aspiration pneumonia
• Ceftriaxone 80mg/Kg/24 hours IM/IV +
Metronidazole 7.5mg/kg every 8 hours
• Refer the patient for possible removal
• Gentle suction of thick secretions from upper
airway maybe supplemental.
Hospital and ventilator-associated
pneumonia
For patients at lower risk of drug resistant organisms,
Ceftazidime Total daily dose 75 mg/kg IV (divided
into 2 doses per day)
• AND
• Gentamicin 3 – 5 mg/kg/day IV (given once daily)
for 7 days
Cont.
Patients at higher risk of drug resistant organisms
• Piperacillin-Tazobactam 100 mg/kg IV q 8 hours for
7 day
Pediatric Meningitis
Introduction
• Meningitis is acute inflammation of the meninges
(the membranes covering the brain).
• It is an acute and one of the most potentially
serious infections in infants and children that
affects the central nervous system
• Infections of the CNS with primary involvement of
the meninges