Pediatric patient pneumonia

Empirical Antimicrobial Therapy for Pneumonia in Pediatric Patients ... 

Higher dose amoxicillin, amoxicillin-davulanate (eg., 90 mg/kg/day) is used for penicillin-resistant Streptococcus pneumoniae fluoroquinolones are avoided in pediatric patients because of the potential for cartilage damage however, their use in pediatrics is emerging. Doses shown are extrapolated from adults and will require further study. 

Adverse reactions occurring in at least 3% of pediatric patients include abnormal gait, aggressive reaction, anorexia, ataxia, confusion, constipation, difficulty with concentration/attention, difficulty with memory, dizziness, epistaxis, fatigue, gastroenteritis, hyperkinesia, increased saliva, injury, insomnia, nausea, nervousness, personality disorder (behavior problems), pneumonia, psychomotor slowing, purpura, skin disorder, somnolence, speech disorders/related speech problems, urinary incontinence, viral infection, weight decrease. 

Pediatric patients (2 months to 16 years of age) - Treatment of uncomplicated and complicated urinary tract infections (including pyelonephritis), uncomplicated skin and skin structure infections, pneumonia, and as empiric therapy for febrile neutropenic patients. 

Bacterial meningitis (pediatric patients 3 months of age or older only) Bacterial meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae ( -lactamase and non- -lactamase-producing strains), and Neisseria meningitidis. 

Ofloxacin interferes with microbial DNA synthesis. It is indicated in the treatment of acnte bacterial exacerbations of chronic bronchitis, commnnity acquired pneumonia, uncomplicated skin and skin structure infections, acute uncomplicated urethral and cervical gonorrhea, nongonococcal urethritis, cervicitis, acute pelvic inflammatory disease, uncomplicated cystitis, complicated urinary tract infections (UTI), and prostatitis cdiV eAhy Escherichia coli. Ophthalmic use for treatment of conjunctivitis and corneal ulcer infections caused by susceptible organisms otic use for treatment of otitis externa, chronic suppurative otitis media in patients with perforated tympanic membranes, and acute otitis media in pediatric patients with tympanostomy tubes. 

ECMO is considered a standard therapy for the treatment of respiratory failure in neonatal patients (Anderson and Bartlett, 2000). In adult and pediatric patients, it is a treatment of last resort for individuals who would otherwise die despite maximal therapy (Anderson and Bartlett, 2000 Bartlett et al., 2000). Even in neonatal cases, ECMO is a therapy reserved for those patients with severe respiratory compromise and a high risk of death who are failing traditional ventilator-based interventions. Common causes of respiratory failure in the neonatal population that are treatable with ECMO support include pneumonia or sepsis, meconium aspiration syndrome, respiratory distress syndrome, persistent fetal circulation, and congenital diaphragmatic hernia (Anderson and Bartlett, 2000). Contraindications to ECMO support include root causes that are unresolvable, such as a major birth defect or genetic abnormality, and comorbid conditions such as intracranial hemorrhage or fetal underdevelopment that suggest a poor outcome (Anderson and Bartlett, 2000). Indications for ECMO use in the pediatric and adult populations are not dissimilar from those of the neonate, but... 

Nosocomial lower respiratory tract infections (LRI) represent a significant concern to those caring for hospitalized infants and children because of both their frequency and their potential severity. Pneumonia is the second most common nosocomial infections in all patients hospitalized in the United States regardless of age (1,2). Data from the National Nosocomial Infections Surveillance (NNIS) System documents that nosocomial pneumonia is the second most frequent hospital-acquired infection in critically ill infants and children as well (2,3). Many of the significant risk factors for the development of nosocomial pneumonia previously identified in adult patients, such as severe underlying cardiopulmonary disease, immunosuppression, depressed sensorium, and prior thoracoabdominal surgery, are present in pediatric patients and place them similarly at risk for nosocomial lower respiratory tract infections. In addition, there are specific clinical situations that are unique for neonatal and pediatric patients that provide additional risks for severe nosocomial lower respiratory tract infections (Table 1). 

Trimethoprim-sulfamethoxazole (TMP-SMX) (20 mg/kg/day of trimethoprim) is the treatment of choice for P. carinii pneumonia (PCP). Oral therapy with TMP-SMX is reserved for children with mild PCP who do not have malabsorption or diarrhea. Intravenous pentamidine (4 mg/kg/day, given once a day) can be given to children with PCP who are intolerant of TMP-SMX or who have not responded after 5 days of TMP-SMX therapy. Other treatment regimens that may be considered for patients who are intolerant of or fail TMP-SMX and pentimidine are (1) atovaquone (40 mg/kg/ day, in two divided doses) for mild/moderate PCP only (2) dapsone with trimethoprim (3) trimetrexate with leucovorin and (4) clindamycin and primaquine. These alternate treatments have limited experience in pediatric patients. 

Influenza viruses A and B can cause pneumonia in pediatric and adult patients. Amantidine and rimantidine are available oral agents with activity against influenza virus type A. If started within 48 hours of the onset of the first symptoms, they reduce the duration of the illness by about 1.3 days. Oseltamivir and zanamivir also are oral agents and are active against both type A and B viruses. These agents also reduce the duration of the illness by about 1.3 days if initiated within 40 to 48 hours of the first symptoms.29 For active infection beyond the first 48 hours, none of these agents is effective in treating the infection, and supportive care is the best treatment for these patients. 

Dean D, Neumayr L, Kelly DM, et al. Chlamydia pneumoniae and acute chest syndrome in patients with sickle cell disease. J Pediatr Hematol Oncol 2003 25 46-55. 

Rowe DS, Michaels RH (1960) Isolation of the respiratory syncytial virus from a patient with pneumonia. Pediatrics 6 623-629... 

Lower respiratory tract infections comprise 6% to 27% of all nosocomial infections detected in a pediatric intensive care setting (3,4,26). The actual frequency of nosocomial pneumonia and tracheitis occurring in hospitalized children varies considerably because of marked differences in patient populations... 

In 1990, the NNIS pediatric hospitals reported 6.4 lower respiratory tract infections that were not pneumonia per 1000 ventilator-days (29). In children hospitalized in pediatric intensive care settings, the vast majority of these infections of the lower respiratory tract would be tracheitis but not pneumonia. Children s Hospital in Columbus, Ohio, has seen a steady increase in the number of lower respiratory fract infections in PICU patients on mechanically... 

Intubation associated with mechanical ventilation is the single most important risk factor for the development of nosocomial pneumonia and tracheitis. Intubation should be used only when medically indicated. Extubation should be accomplished as quickly as it is clinically feasible. It may be appropriate for individual pediatric and neonatal intensive care units to develop criteria for intubation and continued mechanical ventilation. Auditing practice versus predetermined criteria might identify opportunities to reduce patient ventilator-days. 

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